A 38-year-old Caucasian female presented to the office with a 2-week history of peripheral vision loss OD. She reported being in a motor vehicle accident 2 weeks prior where another car ran a stoplight and hit her family’s car head-on into the driver’s side. Her husband was the driver, she was in the front passenger seat, and their 5 children were in the back of the vehicle. Her airbag deployed both from the dashboard as well as from the front seat passenger door to her right which caught her from hitting the passenger door. She did not have any other injuries but started noticing the peripheral vision loss within a few hours. With serious family injuries to attend to, the patient did not seek evaluation until two weeks later. The patient reports the defect has been stable since the accident and has not been associated with any other symptoms such as flashes, floaters, pain, or headache.

Upon visual field testing, the patient was found to have a predominantly inferior temporal defect which respected the vertical meridian OD. OS was WNL. The ocular exam itself was completely normal except for a trace APD OD and vision was 20/20 each eye. Traumatic optic neuropathy was suspected and an MRI of the brain and orbits was ordered with thin slice imaging through the right optic nerve. All MRI testing was WNL.

Traumatic optic neuropathy is likely due to mechanical shearing of the neuronal axons or apoptosis, or both. Studies using high dose corticosteroids have been performed but are controversial as to their results and, when utilized, should preferably be started within hours of the injury. Given this patient’s good vision and 2-week history, we decided to treat with observation only. The patient presented for repeat VF testing over the course of one year. The visual field defect improved but did not resolve completely. She was referred back to her optometrist for yearly eye examinations.