Traumatic optic neuropathy (TON) following blunt orbital trauma is classified by the International Optic Nerve Trauma Study (IONTS). The IONTS showed that corticosteroids versus observation in TON resulted in:

• A Significantly superior visual recovery with megadose methylprednisolone
• B Better outcomes with surgical decompression over corticosteroids
• C No significant difference in visual recovery between corticosteroids, optic nerve decompression, and observation ✓
• D Corticosteroids plus surgery superior to either alone

Explanation

The International Optic Nerve Trauma Study (IONTS, 1999) was a prospective multicentre non-randomised study that compared megadose corticosteroids, optic canal decompression, and observation in TON. No treatment group showed significantly better visual improvement than the others, including untreated controls. This landmark study altered practice away from routine megadose steroids (previously based on NASCIS spinal cord injury data). Current guidance treats TON conservatively; corticosteroids may be used if vision deteriorates, but decompression is not routinely recommended. Spontaneous improvement occurs in approximately 50% of cases.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.