Optic nerve examination

Visual loss due to optic nerve injury after closed traumatic brain injury constitutes a formidable diagnostic and therapeutic challenge for the clinician. Assessment must be made of the site of optic nerve injury, and this is often difficult in the patient with an altered level of consciousness. A decision regarding optic nerve decompression must be formulated, yet the literature is confusing with regard to operative indications.

If conscious: serial quantification of vision in each eye is important ¹⁾.

Rosenbaum near vision card, if not possible check if they can count fingers.

Failing this, check for hand motion vision and lastly light perception.

Children may develop transient cortical blindness.

If unconscious: check for relative afferent pupillary defect with swinging flashlight test.

Funduscopy: check for papilledema, preretinal hemorrhage, retinal detachment or retinal abnormality.