Tuesday, July 27, 2010

Direct Traumatic Optic Neuropathy (Direct TON)

Before I even get to what direct TON is, I want to point out that my feeling guilty ride is over, I have put this in a box, threw it away and I am now moving forward. I am not writing about this to be judged or be called a bad parent. I am writing about this because I doubt many parents are aware of the dangers around kids and pencils or any sharp pointy object for that matter. That includes pencils, markers, keys, small elongated toys, a high heel shoe, etc. I think you get my point. This is a hard subject for me to even touch, but I feel that it is important for me to bring some awareness about this condition and how it is diagnosed.

My 3 1/2 year old daughter, Gianna, fell while she was running from her brother. What neither my husband or I realized was that she had a pencil in her hand. When she fell and I saw her get up, I still didn't know what the situation was but I knew something was wrong. The pencil was on the floor and she was covering her eye. I thought I was going to die!! We called 911 and we were rushed to the emergency room. She had some exposed fatty tissue, her eye was pretty much intact, just a major laceration in her right upper eyelid (or so we were told). They ran X-rays, no foreign objects found, so she was sutured and set home. As expected, she had bruising around her eye, and her eyelid was swollen shut. I did everything possible to make sure she had a quick recovery, and in fact she was able to open her eye about 3 to 4 days later with minimal bruising. We followed up with the surgeon a week later with a complaint that her eye was somewhat deviated. He referred her for an MRI, which we were not able to schedule for another week since she needed to be sedated. Two weeks gone by she goes for the MRI and as I am walking in the door I get the call from the doctor. She needed to be admitted to the hospital for an inflammation in the back of her eye. She received IV steroids treatment for about three days and we were discharged to continue oral steroids at home. While in the hospital they did every test possible including blood work and CT scan to determine why she had vision loss and whether there was an underlying condition causing the inflammation. So what went wrong??

Direct traumatic optic neuropathy in plain English is damage to the optic nerve resulting from an injury. In the case of direct trauma, the injury can result from either a penetrating object or from blunt trauma to the head with bone fractures. Most commonly this can happen in an injury from a gunshot where there has been bone shattered. While a penetrating injury is less common, it does happen. There are not enough articles on the internet or even in the medical community that discuss this type of injury causing it to go unnoticed. There are a few sites that include some articles and even pictures, but I have yet to see some sort of documentation for a penetrating injury with a pencil and how it is treated. It is a shame, because kids are very prone to this sort of injury. The consequences with this type of injury are devastating. Let alone the possibility of brain damage, there is also the chance of partial to complete vision loss in the injured eye. Doctors are also divided as to how this should be treated, but the most common treatment is IV steroids. The problem with an untreated inflammation is further damage to the nerve.

The proper diagnostic testing for this type of injury is a CT scan, and this should be done as soon as you get emergency care. There are several things can be determined with a scan, one being damage to the nerve. Also they can determine if there are any foreign objects in the orbital area or if there has been any damage to the brain. Immediately nerve damage is suspected the doctors should treat with IV steroids as well as antibiotic to prevent further damage to the nerve. Obviously as parents we don't ever expect things like this to happen to our kids. But if you should ever find yourself in a similar situation here are some steps to making sure you are getting them the best care possible:

In my daughter's case, because she was not given the proper diagnostic testing her injury was improperly treated. It is almost like a slap in the face when a doctor tells you how lucky your child is, and later you find out she wasn't so lucky after all. The misconception that just because no one saw this pencil going into her eye or just because the Xray revealed no foreign object, that there was no further damage other than the laceration on her eyelid. As parents you are ecstatic to hear your child is lucky and doing well; and we didn't ask questions we were just elated to go home with a healthy child.

Today Gianna is a perfect 4 year old girl, ready to go to school, ready to explore the world, and legally blind in one eye. Don't feel bad for her, she has not let that hold her down. If you were to see her, you would never know that she has a visual problem. She is required to wear glasses all the time to protect her good eye from an injury. Her vision is 20/200, but quite honestly I believe it to be better than the doctors are able to determine. Mostly, her peripheral vision was affected. As she has learned to adapt to the changes, her left eye is compensating for the right eye making her central vision great and her peripheral vision not so much. She had eye muscle surgery (mostly for cosmetic reasons) so that she looks absolutely normal. And the scar, well that fades with time as do all internal wounds.

I hope that you will find this blog informative and raises awareness. You can be on top of them as much as you can but some times accidents are inevitable and we just learn to deal with the consequences. Til' next time,


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