From the Research
Steroids should not be used as a primary treatment for optic nerve sheath disruption due to the lack of significant benefit in improving visual outcome, as evidenced by the most recent and highest quality study 1. The use of steroids in treating optic nerve sheath disruption is a topic of controversy, with some studies suggesting a potential benefit in reducing inflammation and swelling around the optic nerve. However, the evidence for the efficacy of steroid treatment in improving visual outcome is insufficient, and the risk of significant adverse events, particularly in patients with comorbidities, cannot be ignored 1. Some studies have investigated the use of high-dose intravenous methylprednisolone in the treatment of optic neuritis, with mixed results. For example, a study published in 1998 found that treatment with intravenous methylprednisolone did not improve visual outcome or lesion length in patients with acute optic neuritis 2. In contrast, a study published in 2016 suggested that steroid pulse therapy may be beneficial in patients with indirect traumatic optic neuropathy, particularly those with certain predisposing factors such as female sex, younger age, and lateral force fracture pattern 3. However, when considering the most recent and highest quality evidence, it is clear that the use of steroids in treating optic nerve sheath disruption is not supported. The study published in 2018 1 provides a comprehensive analysis of the current state of the literature regarding the use of steroids in the treatment of optic neuropathies, including optic neuritis, nonarteritic anterior ischemic optic neuropathy, and traumatic optic neuropathy. The authors conclude that the evidence for the efficacy of steroid treatment is insufficient to show significant benefit, and that the risk of adverse events cannot be ignored. In light of this evidence, the use of steroids as a primary treatment for optic nerve sheath disruption is not recommended. Instead, alternative treatments, such as optic nerve sheath decompression, may be considered in selected patients. Patients should be monitored closely for potential side effects, and treatment should be individualized based on the specific clinical presentation and underlying etiology of the optic nerve sheath disruption.