Incidence of Traumatic Optic Neuropathy Associated with Subtypes of Orbital Wall Fracture: A Systematic Review

Abstract Background: Traumatic optic neuropathy (TON) is a rare condition with serious consequences. One common cause of TON is orbital wall fracture, which can occur at any site. This study aimed to report the incidence of TON in orbital wall fractures. Materials and Methods: A systematic search of Medline, Scopus, and the Directory of Open Access Journals (DOAJ) was conducted. The following terms were used: (traumatic optic neuropathy OR blindness) AND (craniofacial trauma OR facial fractures OR fracture pattern OR orbital wall fracture OR Visual field orbital wall fractures) AND (Visual acuity OR Visual evoked potential) AND (Mega-dose steroid therapy OR corticosteroids). This review encompassed both Randomized Controlled Trials (RCTs) and observational investigations, comprising both prospective and retrospective studies. Results: Four studies met our inclusion criteria with 2720 patients included in this study. Most of the patients were males (n = 2175, 80%). A total of 3791 orbital wall fracture subtypes were reported in the included patients. Of them, 1522 patients had multiple fractures. The highest incidence of fracture was floor fracture, with an Event Rate (ER) of 42.2%, followed by lateral fracture (ER = 37.9%), roof fracture (ER = 36.2%), and medial fracture with ER (29%). Motor vehicle accidents were the most common injury mechanism reported in 46 patients, compared with traumatic injuries reported in 23 patients. Conclusion: Lateral and superior orbital wall fractures were the most common orbital fractures in patients with TON. Periorbital hematoma and subconjunctival hemorrhage were the most frequently reported complications. Hence, ophthalmologists treating patients with TON should prepare radiological assessments and consider the surrounding structures to prevent damage to other structures.