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VOLUME
Vol.05 Issue01 2025
PAGE NO.
57-61
10.37547/ijmscr/Volume05Issue01-08
Early diagnosis and prognosis of traumatic optic
neuropathy
Bilalov E.N.
DSc, Professor, Ophthalmology Department, Tashkent Medical Academy, Uzbekistan
Bahritdinova F.A.
DSc, Professor, Ophthalmology Department, Tashkent Medical Academy, Uzbekistan
Narzikulova K.I.
DSc, Associate Professor, Ophthalmology Department, Tashkent Medical Academy, Uzbekistan
Nazirova S.H.
PhD, Associate Professor, Ophthalmology Department, Tashkent Medical Academy, Uzbekistan
Egamberdieva S.M.
Assistant of Ophthalmology Department, Tashkent Medical Academy, Uzbekistan
Oralov B.A.
PhD, Assistant of Ophthalmology Department, Tashkent Medical Academy, Uzbekistan
Pirnazarov M.Y.
Assistant of Ophthalmology Department, Tashkent Medical Academy, Uzbekistan
Received:
23 October 2024;
Accepted:
25 December 2024;
Published:
27 January 2025
Abstract:
Traumatic optic neuropathy (TON) caused by blunt eye injuries represents a significant clinical challenge,
frequently leading to irreversible vision loss. Early diagnosis and monitoring of retinal and optic nerve changes are
crucial for improving patient outcomes. Optical coherence tomography (OCT) offers unparalleled capabilities in
detecting and quantitatively assessing such changes.
Objective. To evaluate the diagnostic potential of OCT in identifying morphological and functional changes in the
retina and optic nerve among patients with TON.
Materials and Methods. A total of 40 patients with blunt eye trauma were examined. The diagnostic protocol
included OCT, computer perimetry, visual acuity testing, and ophthalmoscopy. Parameters of the RNFL, GCIPL,
macula, and optic nerve head were analyzed.
Results. Patients with TON demonstrated significant RNFL thickening in the early stages of trauma, optic nerve
head swelling, and GCIPL thinning, which correlated with impaired visual function. OCT proved to be highly
effective for early diagnosis and monitoring of these changes.
Conclusion. OCT is a pivotal tool for assessing retinal and optic nerve damage in TON, enabling improved
diagnostics, prognostication, and patient management.
Keywords:
Traumatic optic neuropathy, blunt eye trauma, optical coherence tomography, RNFL, GCIPL,
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diagnostics.
Introduction:
Traumatic injuries to the retina and optic
nerve, such as traumatic optic neuropathy (TON),
impose a significant clinical and social burden,
particularly in working-age individuals. These injuries
often result in irreversible vision loss, emphasizing the
critical importance of early diagnosis and effective
treatment to improve outcomes. Advanced imaging
techniques, such as optical coherence tomography
(OCT), offer new possibilities for the early detection
and monitoring of these injuries [1,5,11,12].
Early studies indicate that TON is characterized by
degeneration of ganglion cells and their axons, leading
to notable morphological changes, including thinning
of the retinal nerve fiber layer (RNFL) and the ganglion
cell
–
inner plexiform layer (GCIPL). These changes are
strongly associated with visual impairments, such as
reduced visual acuity, visual field defects, and impaired
color perception. Research suggests that GCIPL is a
more sensitive marker for early changes compared to
RNFL, making it a critical tool for diagnosis and
outcome prediction [2,3,6,8,10].
Moreover, OCT enables the detection of early signs of
optic nerve head and peripapillary retinal edema,
which are not always visible using conventional
examination methods, such as ophthalmoscopy.
Numerous studies have reported increased RNFL
thickness and macular volume within the first days
following eye trauma, underscoring the high sensitivity
of this method and its essential role in identifying even
minimal pathological changes [4,7,9,13,14].
Another crucial aspect is the ability to differentiate
between types of TON, which helps optimize treatment
approaches
by
accounting
for
the
specific
characteristics of each injury [4,9,13]. Combining OCT
with functional tests, such as computer perimetry,
provides a deeper understanding of the mechanisms
underlying optic nerve damage, which is particularly
relevant in the context of personalized medicine.
Thus, OCT not only enhances the accuracy of
diagnosing retinal and optic nerve damage but also
plays a vital role in monitoring and predicting
outcomes. This allows clinicians to make more
informed decisions regarding the management of
patients with TON.
Purpose of the study
To evaluate the potential of optical coherence
tomography for diagnosing and monitoring retinal and
optic nerve changes in patients with traumatic optic
neuropathy and to determine the significance of retinal
nerve fiber layer and ganglion cell
–
inner plexiform
layer parameters for early detection and outcome
prediction.
METHODS
The study included 40 patients (40 eyes) with contusion
eye injuries and clear optical media, who underwent
examinations at the Departments of Traumatology and
Neurosurgery of the Multidisciplinary Clinic of the
Tashkent Medical Academy.
The causes of injuries were diverse: physical
altercations (30%), punches (25%), blunt objects (20%),
road traffic accidents (15%), and sports-related injuries
such as boxing, sparring, and ball impact (10%). The
average age of the patients was 40.8 ± 14.5 years, with
28 men (70%) and 12 women (30%). The mean time
from injury to optical coherence tomography (OCT) was
3.2 ± 1.7 days. A control group was comprised of 30
healthy individuals (20 men and 10 women), matched
for age and gender.
Exclusion criteria included the presence of other ocular
diseases affecting the function and structure of the
optic nerve, severe systemic comorbidities (such as
significant cardiovascular, respiratory, or digestive
system disorders), and an age under 18 years.
All patients underwent a comprehensive examination,
including visual acuity testing, ophthalmoscopy,
standard perimetry, and central visual field testing
using the Humphrey 24/2 program for computer
perimetry. Additionally, magnetic resonance imaging
(MRI) of the brain was performed to rule out associated
injuries.
OCT was conducted using the Huvitz HOCT-1F/1 device
(South Korea). The device features a resolution of 5
–
8
µm, a scanning speed of 26,000 A-scans per second,
and a laser wavelength of 840 nm. The following
parameters were assessed: retinal nerve fiber layer
(RNFL) thickness, macular volume, optic nerve head
(ONH) volume and area, and ganglion cell
–
inner
plexiform layer (GCIPL). Standardized protocols such as
“RNFL
Thickness
Average”
and
“Retinal
Thickness/Volume Tabular” w
ere applied.
Morphometric data of the injured eye were compared
with those of the paired healthy eye and the control
group using the Student's t-test. Differences were
considered statistically significant at p < 0.05. The data
obtained were used to evaluate the degree of
morphological changes in the retina and optic nerve
and to identify correlations with functional
impairments.
RESULTS
The study revealed significant morphological changes
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in the retina and optic nerve in all patients with TON
caused by blunt trauma. These changes affected the
RNFL, GCIPL, macular region, and optic nerve head. The
findings are detailed below.
The average RNFL thickness in injured eyes was 114.2 ±
11.1 μm, which was significantly higher than that in the
healthy paired
eyes (106.5 ± 8.9 μm, p < 0.01). The
increase in RNFL thickness during the acute phase was
associated with peripapillary edema triggered by
traumatic impact. The most pronounced thickening
was observed in the superior and inferior quadrants of
the peripapillary area, where RNFL thickness reached
120.5 ± 10.2 μm (superior quadrant) and 118.7 ± 9.8 μm
(inferior quadrant), compared to the corresponding
values in healthy eyes (112.3 ± 8.7 μm and 110.4 ± 9.1
μm, respectively).
In the temporal quadrant, 42% of patients exhibited
pallor of the optic nerve head, accompanied by a
reduction in RNFL thickness in this region. The average
RNFL thickness in the temporal quadrant of the injured
eye was 88.5 ± 6.9 μm, which was below the normative
value in the control grou
p (93.7 ± 5.8 μm, p < 0.05).
Early degenerative changes in the GCIPL manifested as
thinning, even in the presence of RNFL edema. The
average GCIPL thickness in the injured eye was 70.8 ±
9.7 μm, significantly lower than in the paired healthy
eye (78.2 ± 7.
1 μm, p < 0.05). These changes suggest
initial axonal degeneration caused by optic nerve
trauma. The most significant thinning of the GCIPL was
observed in the central and paracentral regions of the
macula, correlating with functional impairments, such
as reduced sensitivity in the central visual field.
Morphometric changes in the optic nerve head (ONH)
included an increase in its volume and area, linked to
trauma-induced edema and inflammation. The average
ONH volume in the injured eye was 0.47 ± 0.14 mm³,
significantly exceeding that in the healthy eye (0.33 ±
0.09 mm³, p < 0.001). An increase in the neuroretinal
rim area (1.71 ± 0.11 mm² versus 1.26 ± 0.08 mm² in
the healthy eye, p < 0.01) was accompanied by a
reduction in the excavation area (0.07 ± 0.02 mm²
versus 0.12 ± 0.03 mm² in the healthy eye, p < 0.05).
In 32.5% of patients with blunt eye trauma, macular
edema was observed, accompanied by an increase in
macular volume. The average macular volume in the
injured eye was 8.9 ± 0.6 mm³, compared to 7.5 ± 0.4
mm³ in the healthy eye (p < 0.01). Macular edema was
more frequently seen in patients who sustained injuries
from road traffic accidents and blunt object impacts.
To validate the significance of the changes in
morphometric parameters, a comparative analysis was
conducted with a control group of 30 healthy
individuals. The data revealed statistically significant
differences in all key metrics for patients with TON.
These included an 8
–
10% increase in RNFL thickness
during the acute phase, a 9
–
12% reduction in GCIPL
thickness, a 40% increase in ONH volume, and an 18%
increase in macular volume.
In 40% of patients, pallor of the temporal half of the
optic nerve head was observed, correlating with
localized thinning of the RNFL. Additionally, 78% of
patients showed changes in the central and paracentral
macular zones, confirmed by computer perimetry
results.
Morphological changes associated with traumatic optic
neuropathy included peripapillary edema, an increase
in optic nerve head volume, thinning of the GCIPL, and
localized
macular
alterations.
These
findings
underscore the high diagnostic value of OCT for early
detection and monitoring of retinal and optic nerve
changes in patients with blunt eye trauma.
Significant functional impairments of the visual system
were detected in all patients with TON caused by blunt
trauma. These impairments included decreased visual
acuity, disruptions in peripheral and central visual
fields, and reduced sensitivity in central and
paracentral macular zones.
The majority of patients experienced reduced visual
acuity in the injured eye. The average visual acuity was
0.5 ± 0.3 (Snellen scale), significantly lower than that of
the paired healthy eye (1.0 ± 0.1, p < 0.001). In 42% of
patients, visual acuity ranged from 0.3 to 0.5, indicating
moderate visual impairment. In severe cases, especially
those caused by road traffic accidents or blunt object
impacts, visual acuity ranged from 0.1 to 0.2, indicating
significant damage to the optic nerve and retina.
Computer perimetry revealed a significant reduction in
sensitivity in the central and paracentral zones in 82%
of patients. The mean deviation in central field
sensitivity ranged from
–
3.2 to
–
17.4 dB, depending on
the severity of the trauma. Peripheral field constriction
was noted in 65% of patients, predominantly in the
superotemporal
and
inferotemporal
sectors.
Additionally, 30% of cases exhibited isolated color
perception deficits, particularly in red and green,
further confirming optic nerve fiber damage.
Central vision impairment was observed in 78% of
patients. Humphrey 24/2 perimetry revealed reduced
sensitivity in central and paracentral retinal areas,
correlating with GCIPL thinning. In patients with the
most severe central vision loss, GCIPL thickness
decreased to 65.8
± 7.3 μm, significantly lower than in
patients with moderate impairments (73.1 ± 8.5 μm, p
< 0.01).
Relative afferent pupillary defects (RAPD) were noted
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in 58% of patients in the injured eye, indicating
substantial damage to optic nerve fibers responsible
for transmitting visual signals.
Functional changes were closely correlated with the
morphological parameters identified through OCT.
Patients with pronounced reductions in visual acuity
and visual fields demonstrated more severe thinning of
RNFL and GCIPL, confirming a pathogenetic
relationship between structural damage and functional
impairments.
To benchmark functional impairments, visual function
metrics were compared with the control group. Healthy
individuals had an average visual acuity of 1.0 ± 0.0,
visual fields within age-appropriate norms, and central
zone sensitivity ranging from
–
0.5 to 0.5 dB. These
results confirm that the functional impairments in
patients with TON were exclusively trauma-induced.
Functional impairments in traumatic optic neuropathy
include reduced visual acuity, disruptions in peripheral
and central visual fields, and afferent pupillary defects.
These changes strongly correlate with morphological
findings from OCT and highlight the importance of an
integrated diagnostic approach that combines
structural and functional analysis. Early detection of
functional impairments allows for the prediction of
optic nerve damage severity and timely initiation of
therapy.
CONCLUSION
Traumatic optic neuropathy (TON) caused by blunt
injuries leads to significant morphological and
functional changes in the retina and optic nerve. This
study
demonstrated
that
optical
coherence
tomography (OCT) is a highly informative tool for
diagnosing and monitoring these changes. In the early
stages of trauma, OCT detects retinal nerve fiber layer
(RNFL) and optic nerve head (ONH) edema, as well as
initial degenerative changes in the ganglion cell
–
inner
plexiform layer (GCIPL), which are critical markers of
optic nerve damage.
Functional impairments, such as reduced visual acuity,
disruption of central and peripheral visual fields, and
relative afferent pupillary defects (RAPD), strongly
correlate with morphological findings. This highlights
the pathogenetic link between structural damage and
functional deficits. Early detection of these changes
using OCT not only allows for an objective assessment
of injury severity but also facilitates outcome
prediction,
ensuring
timely
treatment
and
rehabilitation.
The findings confirm that OCT can serve as a gold
standard for diagnosing and monitoring traumatic
injuries to the retina and optic nerve. The method
provides detailed evaluations of RNFL thickness, GCIPL
metrics, and macular parameters, paving the way for a
personalized approach to managing TON patients.
Further research with longer follow-up periods and
larger patient cohorts is essential to refine diagnostic
and therapeutic strategies for traumatic optic
neuropathy.
Key findings
Patients with TON caused by blunt injuries exhibited
significant alterations in the retina and optic nerve.
During the acute phase, RNFL and ONH edema were
observed, along with GCIPL thinning, indicative of early
neurodegeneration.
Trauma resulted in reduced visual acuity, disruptions in
peripheral and central visual fields, and relative
afferent pupillary defects. These functional deficits
strongly correlated with the identified structural
changes, confirming their interrelationship.
OCT demonstrated high diagnostic accuracy in
assessing traumatic optic nerve and retinal injuries. It
provided precise measurements of RNFL thickness,
GCIPL, ONH, and macular parameters, establishing its
indispensability for early detection and monitoring of
changes.
Using OCT during the acute phase of trauma enables
the detection of pathological changes at stages when
traditional diagnostic methods are insufficient. This
facilitates timely therapy initiation and outcome
prediction.
The results emphasize the need to integrate OCT into
standard diagnostic protocols for patients with
traumatic injuries to the eye and optic nerve. The
method offers promising opportunities for a
personalized approach to treatment and rehabilitation
in TON patients.
To deepen the understanding of TON pathogenesis and
enhance therapeutic strategies, further studies with
larger patient cohorts and extended follow-up periods
are needed. These investigations will help optimize
diagnostic and treatment approaches, ultimately
improving outcomes for patients with traumatic optic
neuropathy.
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