A BSTRACT Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma that can result in irreversible vision loss. For decades, conservative management with high-dose corticosteroids has been the primary treatment strategy. However, a substantial proportion of patients fail to respond to steroid therapy, prompting increasing use of endoscopic optic nerve decompression (EOND) as a surgical intervention aimed at reducing secondary optic nerve injury and improving visual outcomes. This systematic review aims to evaluate the effectiveness of EOND in improving the visual acuity outcomes in patients with TON and to identify the prognostic factors influencing surgical success. A systematic review was conducted in accordance with PRISMA guidelines. Comprehensive searches of PubMed, MEDLINE, and the Cochrane Library were performed to identify case reports, cohort studies, and clinical trials assessing visual outcomes following EOND in TON patients. Data extraction and methodological quality assessment were independently conducted by reviewers. Nineteen studies met the inclusion criteria. The transnasal sphenoethmoidal approach was the most commonly employed surgical technique. Patients who underwent surgery within 7 days posttrauma demonstrated significantly better visual improvement (63.6%) compared to those operated on after 7 days (35.7%). Patients with residual vision had superior outcomes (78.6%) compared to those presenting with no light perception (38.2%). Cerebrospinal fluid leakage was the most frequently reported complication and generally resolved within 1–2 weeks. EOND is associated with meaningful visual recovery in selected patients with TON, particularly when performed early. Surgical intervention within 7 days of trauma is recommended when no visual improvement is observed after 2–3 days of corticosteroid therapy. Early decompression may mitigate secondary optic nerve damage and improve the long-term visual prognosis.
CHANGAY et al. (Thu,) studied this question.