What Is Optic Nerve Damage?

Optic nerve injury is called traumatic optic neuropathy, and it is one of the common and serious complications in craniocerebral injury, accounting for about 2% to 5% of craniocerebral trauma.

Optic nerve injury

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Optic nerve injury is called traumatic

According to the cause of the injury, it is divided into car accident injuries, fall injuries, and blow injuries. The most common of these are car accident injuries. Due to anatomical structure and physiological characteristics, more than 90% of optic nerve injuries are indirect injuries of the optic nerve tube segment. Direct injury caused by sharp instrument puncture to the optic nerve and direct injury to other parts of the optic nerve are relatively rare in clinical practice. Indirect optic nerve damage refers to the outer side of the orbit, generally refers to the impact of the upper part of the eyebrow arch, the external force is transmitted to the optic nerve tube through the skull, causing optic nerve tube deformation or fracture, causing vision and visual field disorders caused by optic nerve damage.

1. The liver qi is stagnation, Xuanfu occludes the liver as anger, but the Qi is stagnation. The essence of the five internal organs and the six organs is focused on the eyes, due to the drainage of the liver, stagnation of the liver qi, and the obstruction of the pulse channels. Jinjing cannot be glorified, and is blind and blind.

2, liver and kidney yin deficiency, clear blood is not enough liver and blood collection, the eyes get blood and general vision; kidney possession of essence, abundant essence and blood can see everything. The liver belongs to wood and the kidney belongs to water. Water can grow wood, so there are already homologues. If the body is weak, or if the labor is inadequate, it can cause liver and kidney yin deficiency, insufficient blood clearing, and cause the Shenguang to have no roots and see nothing.

3. Deficiency of both Qi and blood is common in severe illness and long-term consumption of sperm blood, or trauma and blood, or trauma has not recovered after surgery, and caused by deficiency of Qi and blood, there is no support for the blind.

4. Shenyang is inadequate, Shenguang fades, and Shenguang is the essence of natural vision in the eyes. The god light source is in the gate of life, through the gall, and it is sent to the heart. If the endowment is weak, the body yang is deficient, or the chronic illness is not healed, and the kidney yang is injured, causing the real life of the kidney to decline, the warmth of the internal organs cannot be warmed, the light of the god is degraded, and the blind is invisible.

The main clinical basis for diagnosing optic nerve damage is traumatic vision loss, visual field defect, and abnormal pupil reflection on light. Comprehensive diagnostic criteria: history of head trauma; visual impairment; dilated pupils on the injured side, direct photoreaction disappears, and indirect photoreaction exists; fundus examination is normal in the early stage, and optic nerve atrophy can be seen in the later stage; visual field is not completely lost in vision The defect is most common in the lower half of the visual field; the pupil on the ipsilateral side is dilated, and the direct reflection of light is dull or disappears. The indirect reflection of light may be the only sign of optic nerve damage.

During the inspection, first observe the pupil of the affected eye, then observe the pupil of the healthy eye, otherwise the observation time is long, and the two pupils can be the same size, which interferes with the diagnosis of optic nerve damage. The fundus can be normal early. For unconscious persons, the pupils of the affected eyes are dilated, and the direct or disappearance of light response or indirect normal response to light are typical signs of optic nerve damage.

Once the disease is diagnosed, it should be rescued immediately while treating brain trauma. Treatment of optic nerve injury ^[1] , reduce oppression of the optic nerve, prevent and treat vasoconstriction and spasm after injury, promote blood circulation and recovery of optic nerve conduction function. After craniocerebral trauma, it is mainly to save craniocerebral trauma and life. Optic nerve damage can not be found or ignored, and even this problem has not been considered. When the condition is stable, the visual impairment is found. At this time, the ophthalmic consultation has passed. For days, tens of days, or longer, the timing of treatments that may be effective is delayed. Some scholars believe that timely decompression of the optic nerve injury (within 48 h) is significantly better than advanced decompression (within 14 days).

Surgical treatment

Surgery indications and timing: There is no uniform standard for surgical treatment of optic nerve injury. Whether or not the operation depends on the patient's symptoms, vision loss, vision requirements, whether accompanied by other eye diseases, age, and contralateral eye conditions.

The following situations can consider surgery:

1. Vision is 0.1 or below, without permanent macular damage.

2. Visual acuity of 0.4 or more, but with severe diplopia and visual deformation (for patients who require better visual effects, surgery can be attempted by skilled surgeons).

3. Visual acuity is better, but fluorescein imaging shows fluorescein leakage or macular edema.

4. Optic nerve injury after retinal detachment should be stabilized before surgery without active contraction.