Traumatic Optic Neuropathy Clinical Presentation

Updated: Aug 07, 2020
  • Author: Ryan S Jackson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Patients with traumatic optic neuropathy (TON) present with vision loss after blunt or penetrating trauma. Symptoms consist of acute unilateral decrease in vision or visual fields. Delayed diagnosis may occur secondary to other injuries related to the trauma, such as a traumatic brain injury. Such injuries would delay the presentation, and thus the evaluation, of any ophthalmologic injury. 


Physical Examination

Physical examination consists of a full ophthalmologic evaluation, including for obvious signs of trauma, such as ecchymosis, hematoma, lacerations, and bony step-offs. In addition, neurologic examination evaluating for decreased visual acuity and afferent pupillary defect should be carried out. Lastly, funduscopic examination should be performed; initial funduscopic assessment may reveal a normal optic nerve appearance, since optic atrophy may not be evident at the time of presentation.