Pediatric Traumatic Optic Neuropathy: A Case of Emergency Multidisciplinary Surgical Decompression
DOI:
https://doi.org/10.46900/apn.v8i2.379Keywords:
traumatic optic neuropathy, orbital roof fracture, pediatric trauma, optic nerve decompression, emergency surgeryAbstract
Background: Traumatic optic neuropathy (TON) following orbital roof fractures is rare in pediatric populations but represents a surgical emergency due to risk of permanent blindness. Approximately 1.6% of traumatic brain injury cases involve direct optic nerve injury. Orbital roof fractures in children are uncommon and may be associated with frontal lobe injury, dural tears, and proptosis. Early recognition and multidisciplinary intervention are critical for visual preservation.
Case Presentation: A 2-year-old girl sustained high-energy motor vehicle trauma resulting in left orbital roof fracture with optic nerve compression. Clinical examination revealed proptosis, anisocoric pupil without photoreaction, and restricted ocular movement. Computed tomography confirmed displaced orbital roof fracture compressing the optic nerve. Emergency multidisciplinary surgery was performed via medial superior palpebral approach with bone fragment repositioning and optic nerve decompression. Intraoperative cerebrospinal fluid leak resolved spontaneously with conservative management. At 28 months postoperatively, the patient demonstrates complete visual recovery without diplopia, exophthalmos, or dystopia.
Conclusion: Pediatric orbital roof fractures with optic nerve compression require immediate surgical decompression to prevent permanent visual loss. Multidisciplinary collaboration between neurosurgery, oral-maxillofacial surgery, and ophthalmology is essential. Despite potential complications including CSF fistula, timely intervention can achieve excellent functional outcomes.
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Copyright (c) 2026 Déborah Laurindo Pereira Santos , Renato Torres Augusto Neto , Mário Francisco Real Gabrielli, Eduardo Hochuli Vieira
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