The Clinical Features and Surgical Outcomes of Traumatic Optic Neuropathy in Pediatric Patients

This study aimed to examine the clinical features and assess the surgical outcomes of traumatic optic neuropathy in pediatric patients. A retrospective analysis was conducted on the clinical data of 15 cases (17 eyes) of traumatic optic neuropathy in pediatric patients aged 1 to 6 years between January 2015 and July 2024. Two of them presented with binocular trauma, resulting in a total of 17 affected eyes. The injuries were attributed to various causes: 4 cases resulted from falls, 5 from car accidents, and 6 from localized impact trauma. Of the 15 patients (17 eyes), 10 patients (12 eyes) demonstrated postoperative improvement. Preoperatively, 3 eyes had residual vision, all of which revealed improvement following surgery. Among the 14 eyes with no light perception, 9 exhibited postoperative improvement. In one case (1 eye), where the interval between trauma and surgery was within 7 days, treatment was effective postoperatively. In 14 cases (16 eyes), where the interval exceeded 7 days, 11 eyes revealed postoperative improvement. Radiologic examination revealed optic canal fractures or optic nerve swelling in 6 cases. All patients underwent surgical intervention: 1 patient (1 eye) underwent transnasal endoscopic left orbital apex decompression combined with left periorbital hematoma evacuation, while 14 patients (16 eyes) underwent transnasal endoscopic optic nerve decompression. Imaging assessments should be integrated into the diagnostic process to help in selecting the most appropriate surgical approach for pediatric patients with traumatic optic neuropathy. Transnasal endoscopic optic nerve decompression significantly enhances the prognosis in these cases.