Clinical characteristics, management and visual outcomes of traumatic optic neuropathy: a five-year retrospective study from a tertiary referral centre.
TL;DR
Visual outcomes in TON are variable and unpredictable, highlighting the importance of early neuro-ophthalmic assessment, close visual monitoring, and appropriate counselling regarding the guarded visual prognosis.
Abstract
Background
Traumatic optic neuropathy (TON) is a potentially blinding complication of craniofacial trauma with an uncertain prognosis and no established standard of care. Evidence on outcomes and prognostic factors remains limited, particularly in Southeast Asian populations.
Methods
A retrospective observational study was conducted at a tertiary referral centre in Malaysia between September 2020 and August 2025. Patients diagnosed with TON were identified through medical record review. Visual acuity (VA) was categorised according to the World Health Organization (WHO) visual impairment classification. Visual outcomes at one-year follow-up were analysed using the Wilcoxon signed-rank test, and factors associated with visual improvement were evaluated using Fisher's exact test.
Results
Fifty-eight patients were identified, of whom 54 had complete data for visual outcome analysis. The median age was 23.5 years, and most patients were male (82.8%). Road traffic accidents were the predominant aetiology, accounting for 86.2% of TON cases. TON occurred across all traumatic brain injury severities, with comparable distribution in mild and severe cases. At presentation, 53.8% had severe visual impairment, including 13.8% with no perception of light. There was a statistically significant overall improvement in visual acuity at one-year follow-up compared with baseline (p = 0.003). However, subgroup analysis showed no significant association between treatment modality and visual improvement. Visual improvement was also not significantly associated with age, baseline severity, timing of corticosteroid initiation, or the presence of orbital or skull fractures and intracranial haemorrhage (all p > 0.05).
Conclusion
Visual outcomes in TON are variable and unpredictable, highlighting the importance of early neuro-ophthalmic assessment, close visual monitoring, and appropriate counselling regarding the guarded visual prognosis. Due to the relatively small sample size of this cohort, these findings may not be generalisable to broader populations.