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Traumatic optic neuropathy in zygomaticomaxillary complex fractures

Traumatic optic neuropathy (TON) is uncommon, yet a serious sequela to a facial injury. The American Medical Association equates the total loss of vision in one eye to a 24% impairment of a whole man. Literature from the late 90s state, the occurrence of some 55 million eye injuries globally per day. Poor visual perception in 3% of maxillofacial trauma cases was evident in Indian studies carried out in 2011. This has been attributed in most cases to TON resulting from indirect injury to the optic nerve. Clinical diagnosis of TON is made on the basis of a specific constellation of history and physical examination findings. Magnetic resonance imaging with its inherent superior soft tissue contrast resolution has helped identify this problem early to a certain extent. However, the clinical situations characteristic of this type of injury makes a diagnosis and early surgical intervention difficult. Its management remains controversial, and data in literature does not indicate anyone to be superior to the other. Here, we present our experience with a case which fell into this much-disputed category.