Abstract
Decreasing visual acuity secondary to orbital trauma or orbital and anterior skull
base surgery may be caused by either sudden space-occupying intraorbital lesions,
including retrobulbar hemorrhage (RBH), or direct damage to the prechiasmatic pathway.
Contrary to traumatic optic neuropathy, RBH must be diagnosed and treated immediately
to prevent permanent damage to the visual system. Therefore, monitoring and handling
of visual pathway damage are mandatory. Flash visual evoked potentials and electroretinograms
can provide evidence of the status of conductivity of the visual pathway when clinical
assessment is not feasible. Both are thus essential diagnostic procedures not only
for primary diagnosis but also for intraoperative evaluation. In case of RBH surgical
decompression is compulsory. However, traumatic optic neuropathy does not respond
to either corticosteroids or optic canal surgery. Modern craniomaxillofacial surgery
requires detailed consideration of the diagnosis and treatment of traumatic visual
pathway damage with the ultimate goal of preserving visual acuity.
Keywords
retrobulbar hematoma/hemorrhage - optic nerve decompression - traumatic optic neuropathy
- TON - visual pathway damage - flash visual evoked potentials - VEPs
