A 2-year prospective surveillance of pediatric traumatic optic neuropathy in the United Kingdom.

BACKGROUND: To report epidemiologic data on traumatic optic neuropathy (TON) in patients less than 18 years of age in the United Kingdom acquired by prospective population-based active surveillance through the British Ophthalmic Surveillance Unit.

METHODS: Data were obtained from incident and 6-month follow-up questionnaires sent to reporting ophthalmologists over a period of 2 years. Main outcome measures were demographic data, clinical and visual function at presentation and follow-up, investigations, and treatments used.

RESULTS: A total of 26 cases (21 males) were identified; follow-up data were available for 23 (88%). Minimum estimated annual incidence was 0.99 cases per million. Leading causes of TON included 6 sports injuries (23%), 5 falls (19%), and 4 traffic accidents (16%). Presenting best-corrected visual acuity was ≤ 6/60 in 15 cases (58%), with no light perception in 7 cases (27%). Associated injuries were as follows: nonpenetrating injuries, 8 (31%); adnexal injuries, 3 (11.5%); orbital fractures, 5 (19%); skull fractures, 3 (12%); intracranial bleeding, 1 (4%). Fourteen (54%) received no treatment, and 9 (35%) were treated with steroids. Final visual acuity improved in 7 of 21 patients (33%), with 13 of 23 (56%) achieving final visual acuity ≤ 6/60, 10 of whom (43%) had no light perception. Baseline visual acuity was associated with last follow-up visual acuity (P = 0.03), but treatment and improvement of visual acuity by at least 3 lines were not associated. Treatment was more common in children with poor presenting vision (P = 0.03).

CONCLUSIONS: The incidence, natural history, poor presenting visual acuity, and male prevalence of TON in children appear similar to adults in adults in the UK.