Traumatic Optic Neuropathy After Head Trauma: Pathophysiology, Interventions, and Evidence From Meta‐Analysis
Bibliographic record
Abstract
BACKGROUND: Traumatic optic neuropathy (TON) is a vision-threatening complication of craniofacial trauma that often progresses to optic nerve atrophy and irreversible visual loss. However, the optimal management strategy remains controversial. OBJECTIVE: This systematic review and meta-analysis aimed to compare the efficacy and safety of surgical optic canal decompression versus corticosteroid therapy in patients with TON. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for studies published between January 2005 and July 2025. Both randomized controlled trials and observational studies reporting visual or structural outcomes were included. Data were pooled using a random-effects model, and subgroup analyses were performed according to intervention timing, type of injury, and baseline severity. Risk of bias was assessed with RoB 2.0 and the Newcastle-Ottawa Scale. RESULTS: Thirty-four studies involving 1046 patients were included. Surgical decompression significantly improved visual outcomes compared with corticosteroids (62% vs. 37%; OR = 2.35, 95% CI: 1.55-3.56). Subgroup analyses indicated superior outcomes with early surgery (≤ 7 days; OR = 2.91, 95% CI: 1.74-4.88) and in indirect TON (OR = 2.62, 95% CI: 1.70-4.04), whereas benefits were less pronounced in direct injuries. Structural outcomes also favored surgery, with greater retinal nerve fiber layer preservation (mean difference = +9.4 μm) and lower incidence of optic atrophy (OR = 0.44, 95% CI: 0.27-0.71). Adverse events were mild and comparable between groups. Funnel plot analysis revealed no significant asymmetry, suggesting minimal publication bias. CONCLUSIONS: This systematic review and meta-analysis provides indicative evidence that early surgical decompression may offer superior outcomes compared with corticosteroid therapy, especially for indirect injuries. Specifically, this meta-analysis suggests that surgical intervention may offer superior outcomes without increasing adverse events. Nevertheless, the evidence base remains limited, and these results should be interpreted with caution. While corticosteroids alone show limited benefit and may be considered adjunctive when surgery is not feasible, high-quality multicenter randomized trials are urgently needed to standardize treatment protocols and optimize patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.040 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.040 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".