摘要
外伤性视神经病变(TON)是导致严重视功能障碍的急性视神经损伤,为颅面外伤的一种常见并发症,病因分为直接损伤或间接损伤,后者更常见.近年来,TON的发病率呈逐渐上升趋势,一旦发生可能会严重影响患者生活质量,故需早期诊断并及时治疗.TON的诊断除了眼科常规检查外,还需结合神经眼科及电生理、影像学辅助检查.由于缺乏明确的临床指南,其治疗尚无统一的标准.TON的临床治疗包括仅观察及保守治疗、单独使用皮质类固醇治疗或不同方式的视神经减压(使用或不使用类固醇).本文总结近年文献的主流观点,就TON的病因、损伤机制、诊断、治疗及一些尚处于实验阶段但具备治疗前景的方法等进行综述.
Abstract
Traumatic optic neuropathy (TON) is an acute optic nerve injury that results in severe visual impairment. It is a common complication of craniofacial trauma,which can be direct or indirect,with indirect injuries being more common. In recent years,the incidence rate of TON is on the rise. Once it happens,TON may seriously affect the patient's quality of life,so early diagnosis and timely treatment are needed. The diagnosis of TON depends on careful ophthalmic examination,including neuro-ophthalmologic observation of the pupils,VEP,OCT,magnetic resonance imagine and other examination . However,due to the lack of clinical guidelines,there is no unified standard for its diagnosis and treatment. The clinical treatment of TON includes only observation and conservative treatment,the use of corticosteroids alone,or optic nerve decompression (with or without steroids). But in clinical practice,there is some controversy about which method is the best of treatment. This article summarizes the mainstream viewpoints of recent literature and provides a review on the etiology,injury mechanism,diagnosis,treatment,and some methods that are still in the experimental stage but have therapeutic prospects for TON.
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