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Misha Pless, MD
A 23-year old woman presents to the emergency department after a bicycle fall, complaining of anosmia and central blurring of the right eye. She was not wearing a helmet at the time of trauma and there was no report of loss of consciousness. On examination she has a bruise and a 6 cm laceration over the right brow. Her best-corrected visual acuity is 20/100 OD and 20/20 OS. She can only see the control plate on color tests OD and has a relative afferent pupillary defect of the right eye. Eye movement, external, and funduscopic examinations are normal. She has a small, central scotoma in the right eye and the left eye has normal field parameters. Orbital computed tomography (CT) scanning shows a minimally displaced fracture of the sphenoid bone of approximately 0.5 mm, causing mild disruption of continuity of the optic canal. Orbital magnetic resonance image (MRI) scanning shows similar findings. Additionally, there is signal change in the intracanalicular portion of the optic nerve, suggesting edema.
Which of the following statements is true:
- The diagnosis of indirect traumatic optic neuropathy is given to the patient and she is sent home with an oral prednisone taper.
- The patient is informed that optic canal decompression is indicated and effective in providing her the only chance of visual recovery along with corticosteroids.
- Trans-ethmoidal, fiberoptic-endoscopic approach should be used concurrently with high-dose methylprednisolone to decompress the optic canal thus ensuring a better prognosis.
- Methylprednisolone 30 mg/kg loading dose, followed by a 5.4 mg/kg/hr drip for 2 to 3 days intravenously should be given.
- The patient is informed that there is no need for treatment because her visual function is well preserved.
(Click on an answer to see if it is correct)