🛑 Acute progressive optic neuropathy
✍️ Due to
☝️ compression of the nerve by involved tissues (mainly muscles)
☝️ proptosis-induced stretch of the optic nerve
✍️ Assessment by optic nerve function
☝️VA
☝️colour
☝️VF
☝️pupillary reactions
Acute progressive optic neuropathy treatment
✍️ medical decompression
☝️oral prednisolone (1 to 2 mg/kg /d )
☝️pulsed IV methylprednisolone (0.5 to 1 g /d ) for the first 3d).
☝️response rates for oral steroid 75 % and IV steroid 78 %.
☝️Monitor response over 1 to 2 wk.
☝️repeat doses of IV Methylprednisolone may be given. At maximum dose 8 gm to avoid small risk (0.8%) of acute liver damage.
✍️ surgical decompression .
☝️decompress the orbital apex where compression is often maximal.
☝️Don’t operate on an angry 
😡 eye ( should be cool 
😎 with steroid first )
☝️proptosis < 22 mm
• Lateral wall
• fat decompression
☝️ proptosis from 22 to 25 mm
• Lateral wall
• fat decompression
• medial wall decompression
☝️ proptosis > 25 mm
• Lateral wall
• fat
• medial wall decompression
• posterior orbital floor decompression
• superior wall ( if needed by neurosurgeon)
☝️ orbital decompression can be done endoscopically ( inferior and medial wall ) by well trained oculoplastic and otolaryngologist
🛑 Exposure keratopathy
✍️ due to
☝️proptosis
☝️lid retraction.
✍️ Assessment
☝️corneal integrity
☝️tear film
☝️lid closure
☝️proptosis.
✍️ Treatment
☝️lubricants
☝️taping
☝️Frost suture
☝️tarsorraphy
☝️ amniotic membrane graft
☝️acute immunosuppression (systemic steroids)
☝️orbital decompression.
