FIELD OF THE INVENTION
[001] The present invention relates to the field of medical science, and more particularly, the present invention relates to traumatic optic neuropathy in head injuries.

BACKGROUND FOR THE INVENTION:
[002] The following discussion of the background to the invention is intended to facilitate an understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to is published, known, or part of the common general knowledge in any jurisdiction as of the priority date of the application. The details provided herein the background if belongs to any publication is taken only as a reference for describing the problems, in general terminologies or principles or both of science and technology in the associated prior art.
[003] Head injury accounts for approximately 3.4% of all emergency presentations.Up to 84% ocular involvement has been reported in head injury.The immediate impact of head injuries threatening other vital organs is so compelling that damage to the visual system is often ignored. Injuries in the optic nerve following trauma can be of two types, direct and indirect. Indirect injuries result from concussive forces which are transmitted to the optic nerve as a result of cranial or orbito-facial trauma. The bony optic canal is the most common site of optic nerve injury, referred to as an intracanalicular injury. The next common site is the intracranial optic nerve. Indirect damage is the most common cause of traumatic optic neuropathy and occurs in 0.5 to 5% of all closed-head trauma cases. Direct injuries are open injuries where an external object penetrates the tissues and damages the optic nerve. However, it does not occur at the same frequency as indirect optic neuropathy. Commonly, patients with traumatic optic neuropathy have a vision that is 20/400 or less in the affected eye. However, the clinician must maintain a high index of suspicion to avoid missing more subtle cases of traumatic optic neuropathy. Comparative data from International Optic Nerve Trauma Study (IONTS) show that neither corticosteroid therapy nor optic nerve decompression is the gold standard treatment of traumatic optic neuropathy. However,cook et al (1996) in a meta-analysis reported that recovery of vision in patients treated with mega-dosage steroids or surgical decompression of the optic nerve is significantly better than those receiving no treatment. 8 Proper assessment of ocular damage and early initiation of treatment after the injury has an important effect on the final outcome. Therefore, early diagnosis is imperative to prevent visual morbidity caused by trauma.
[004] In light of the foregoing, there is a need for a study of traumatic optic neuropathy in a head injury that estimates the incidence of traumatic optic neuropathy, obtains demographic data, and documents concurrent injuries in cases of head injury and that overcomes problems prevalent in the prior art.

OBJECTS OF THE INVENTION:
[005] Some of the objects of the present disclosure, which at least one embodiment herein satisfies, are as follows.
[006] The principal object of the present invention is to overcome the disadvantages of the prior art by providing a study for traumatic optic neuropathy in head injuries.
[007] The object of the present invention is to provide a study for traumatic optic neuropathy in head injuries, wherein the study estimates the incidence of traumatic optic neuropathy.
[008] Another object of the present invention is to provide a study for traumatic optic neuropathy in head injuries, wherein the study obtains demographic data.
[009] Yet another object of the present invention is to provide a study for traumatic optic neuropathy in head injuries, wherein the study documents concurrent injuries in cases of head injury.
[010] Other objects and advantages of the present disclosure will be more apparent from the following description, which is not intended to limit the scope of the present disclosure.

SUMMARY OF THE INVENTION:
[011] The proposed invention relates to traumatic optic neuropathy in head injuries.Head injury accounts for approximately 3.4% of all emergency presentations. The role of ocular injuries secondary to head trauma in the causation of blindness continues to be an immense public health problem. This study is aimed to estimate the incidence of traumatic optic neuropathy, obtain demographic data, and document concurrent injuries in cases of head injury.
[012] In one aspect of the present invention, a total of 510 patients presenting with head injuriesare examined for all the ocular injuries. The severity of the head.
[013] In one aspect of the present invention, the injury is graded according to Glasgow Coma Scale (GCS). Computed tomography (CT) scan of head is done in all the patients.
[014] In one aspect of the present invention, visually evoked potential (VEP) is done in patients who had relative afferent pupillary defect (RAPD) and defective color vision.
[015] In one aspect of the present invention, the diagnosis of traumatic optic neuropathy isconfirmed on the basis of VEP.
[016] In one aspect of the present invention, the majority of the people affected are males (77.5%). The patients between 16-45 years are affected the most.
[017] In one aspect of the present invention, the most frequent site of injury isthe roadside (72.55%).
[018] In one aspect of the present invention, ophthalmic involvement is observed in 313 individuals (61.4%).
[019] In one aspect of the present invention, abnormal uni-ocular color vision is found in 21(4.11%) patients. RAPD is found in 24 (4.70%) patients. VEP is abnormal in 10 (1.96%) patients, of all the cases of head injury.
[020] In one aspect of the present invention, there is a 1.96% incidence of traumatic optic neuropathy in patients of head injury. Among all the ocular findings, eyelid ecchymosis with edema is most common. Intracranial hemorrhage is the most common CT scan finding in head injury patients.
[021] In one aspect of the present invention, the chances of ophthalmic manifestations are much more when there is intracranial bleeding and facial fractures.

BRIEF DESCRIPTION OF TABLES:
[022] Reference will be made to embodiments of the invention, examples of which may be illustrated in accompanying tables. These tables are intended to be illustrative, not limiting. Although the invention is generally described in the context of these embodiments, it should be understood that it is not intended to limit the scope of the invention to these particular embodiments.
[023] Table 1 shows a table for the location of the site of trauma, in accordance with the present invention.

[024] Table 2 shows a table for the incidence of Traumatic optic neuropathy according to the severity of head injury (total number of patients, n= 510), in accordance with the present invention.
Table 3 shows a table for pupillary involvement in the study groupin accordance with the present invention.

[025] Table 4 shows a table for optic disc findings in the study group system in accordance with the present invention.

[026] Table 5 shows a table for shows comparison between those without and with intracranial hemorrhage in accordance with the present invention.

DETAILED DESCRIPTION OF TABLES:
[027] While the present invention is described herein by way of example using embodiments and illustrative tables, those skilled in the art will recognize that the invention is not limited to the embodiments of table or tables described and is not intended to represent the scale of the various components. Further, some components that may form a part of the invention may not be illustrated in certain figures, for ease of illustration, and such omissions do not limit the embodiments outlined in any way. It should be understood that the tables and the detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the scope of the present invention as defined by the appended claim.
[028] As used throughout this description, the word "may" is used in a permissive sense (i.e. meaning having the potential to), rather than the mandatory sense, (i.e. meaning must). Further, the words "a" or "an" mean "at least one” and the word “plurality” means “one or more” unless otherwise mentioned. Furthermore, the terminology and phraseology used herein are solely used for descriptive purposes and should not be construed as limiting in scope. Language such as "including," "comprising," "having," "containing," or "involving," and variations thereof, is intended to be broad and encompass the subject matter listed thereafter, equivalents, and additional subject matter not recited, and is not intended to exclude other additives, components, integers, or steps. Likewise, the term "comprising" is considered synonymous with the terms "including" or "containing" for applicable legal purposes. Any discussion of documents, acts, materials, devices, articles, and the like are included in the specification solely for the purpose of providing a context for the present invention. It is not suggested or represented that any or all these matters form part of the prior art base or are common general knowledge in the field relevant to the present invention.
[029] In this disclosure, whenever a composition or an element or a group of elements is preceded with the transitional phrase “comprising”, it is understood that we also contemplate the same composition, element, or group of elements with transitional phrases “consisting of”, “consisting”, “selected from the group of consisting of, “including”, or “is” preceding the recitation of the composition, element or group of elements and vice versa.
[030] The present invention is described hereinafter by various embodiments with reference to the accompanying drawing, wherein reference numerals used in the accompanying drawing correspond to the like elements throughout the description. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiment set forth herein. Rather, the embodiment is provided so that this disclosure will be thorough and complete and will fully convey the scope of the invention to those skilled in the art. In the following detailed description, numeric values and ranges are provided for various aspects of the implementations described. These values and ranges are to be treated as examples only and are not intended to limit the scope of the claims. In addition, several materials are identified as suitable for various facets of the implementations. These materials are to be treated as exemplary and are not intended to limit the scope of the invention.
[031] The present invention relates to traumatic optic neuropathy in head injuries.
[032] This cross sectional and observational study is done at a tertiary care center of North India after getting approval from the institute’s ethics committee. All new patients who are more than 5 years of age and presented with head injury are included in the study. Patients with known case of any intracranial pathology, pre-existing ocular abnormalities that might affect assessment of visual function, previous history of any intracranial surgery, and patients with history of prolonged drug intake affecting optic nerve function are excluded from this study. Patients presented to the emergency department, are first stabilized and the Glasgow Coma Scale (GCS) is recorded in all cases. Classification of severity of head injury is done by using GCS scoring system. GCS of 13- 15 is classified as mild head injury, 9-12 as moderate head injury and 3-8 as severe head injury. A detailed history is obtained from all patients or from relative if patient is unconscious. Visual acuity is noted in all stable patients who are conscious and well oriented to time, place and person and is converted to logMar units. Bedside vision is noted in all immobile patients who are conscious and oriented. Color vision is checked bedside with ischihara chart with best corrected visual acuity for near.
[033] A thorough clinical examination is undertaken with a torch light and slit lamp to examine the anterior segment.
[034] The fundus examination is done bedside with the use of indirect ophthalmoscope. Computed Tomography (CT) of all patients of head injury is done in which, firstly a tomogram is done and then scans are taken from base of skull to vertex. Visually evoked potential (VEP) of patients who had relative afferent pupillary defect (RAPD) with color vision defect is done. VEP reporting is done by a neurophysician. All cases of optic neuropathy are confirmed by an abnormal VEP.
[035] A total of 510 patients of head injury are studied. Patients between 16-45 years are affected most (61.56%), with mean age of 33.1 + 17.7 years. Majority of the people affected are males (77.5%) with a male: female ratio of 3.4:1. Most of the patients presented within first 6 hours of head injury (51.76%). Most patients had a mild head injury (60.39%) according to GCS score. Moderate head injury is seen in 14.9% whereas severe head injury is noted in 24.7% patients. It is observed in our study that there is significant statistical association of ocular trauma with severity of head injury (p=0.04). Incidence of traumatic optic neuropathy is found to be 1.96% (n=10). No patients are found to have direct optic nerve injury. Of all the patients with optic nerve injury, only 1 patient had severe head injury, 4 had moderate and 5 had mild head injury.
[036] Most common location of injury is roadside (72.55%). Table 1 shows the location of injury. Ophthalmic involvement is seen in 313 individuals (61.4%). Visual acuity and color vision is obtained in 335 (65.69%) patients who are conscious and oriented to time, place and person. The mean presenting visual acuity is 0.32+0.41 logMAR units. Abnormal uni-ocular color vision is found in 21(4.11%) patients. No patient had binocular color vision defect. Optic nerve involvement is seen in 30 (7.99%) patients. No patients in the present study had an avulsed optic nerve. Table 3 and 4 describe the pupillary and optic disc findings in patients of head injury. RAPD is found in 24 (4.70%) patients. VEP is abnormal in 10 (1.96%) patients, among all the cases of head injury.
[037] On multivariable regression analysis adjusting for mode of injury, those with intracranial haemorrhage had a 66% higher likelihood (Odds ratio=1.66, 95% CI = 1.2–2.4, p=0.006) of having ocular involvement of some form compared to those without the intracranial haemorrhage. (Table 5) No significant association is found between optic nerve injury and the severity of the head injury.
[038] Ocular trauma refers to any injury to the eye. The role of ocular injuries secondary to head trauma in the causation of blindness continues to be an immense public health problem. The damage to the visual system is often ignored in cases of head injury due to injury to other vital organs. Consequently, the socioeconomic impact of ocular trauma can hardly be overestimated as those affected often have to face loss of career opportunities, major lifestyle changes, and occasionally permanent physical disfigurement. 3 In this study, the most common age group is 16-25 years (29.15%), among which most of the patients are males (77.5%) and the most frequent site of injury noted is roadside (72.55%). This trend is thought to be due to the activeness of the young adult in production activities which, in one way or another other exposes them to trauma related to transportation or their activities. This is also the group that commonly involve in social activities such as drinking which may further expose them to accidents due to reckless driving and assault. In the present study, ophthalmic involvement is observed in 61.4% patients. This can be due to direct or indirect injury to the globe by counter coup mechanism, injury to visual cortex or due to trauma to the second, third, fourth, fifth or the sixth cranial nerve. Similar findings are observed in studies conducted by Faith et al and Stanslaus in which ocular involvement is seen in 68.7% and 65.6% cases respectively. 9,10 Pupillary signs are of grave importance in indicating the site and severity of injury and in the prognosis of head injury. Pupillary abnormalities may be due to direct injury to the iris, optic nerve injury or due to central lesions. Presence of RAPD signifies optic nerve involvement. In the current study, RAPD is seen in 4.7% of all the cases of head injury. In study done by Faith et al pupillary abnormalities are seen in 21.7% patients of head injury and in another study done by Smruthi et al pupillary involvement is in 19% of cases of head injury. 9,11 Clinical diagnoses of optic neuropathy can be made on the basis of color vision defect, RAPD and abnormal VEP in the same eye. In the present study, abnormal color vision is seen in 21 (4.11%) patients. RAPD is present in all the patients with color vision defect indicating optic neuropathy. The diagnosis of traumatic optic neuropathy is confirmed by abnormal VEP. In the present study, 10 of total 510 patients of head injuries had an abnormal VEPThe incidencece of traumatic optic neuropathy is found to be 1.96%. In a study done by Pakalpati et al 1.88% of patients with of head injury had traumatic optic neuropathy. Malik et al in their study showed 1.58% incidence of traumatic optic neuropathy in closed-head injury patients. 12,13 On comparing those with and without intracranial haemorrhage, it is found that those with intracranial haemorrhage had significantly lower GCS score and lower presenting vision compared to those with no intracranial haemorrhage. The lower vision is attributable to greater ocular involvement, greater extraocular muscle restriction due to cranial nerve palsy, greater lid involvement, and greater pupillary abnormalities.
[039] The incidence of traumatic optic neuropathy in patients with a head injury is 1.96% in the current study. It is recommended that all patients with head trauma must undergo an ophthalmic examination. The limitation of our study is that VEP of all patients could not be done.
[040] The disclosure has been describing with reference to the accompanying embodiments herein and the various features and advantageous details thereof are explained with reference to the non-limiting embodiments in the following description. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein.
[041] The foregoing description of the specific embodiments so fully revealed the general nature of the embodiments herein that others can, by applying current knowledge, readily modify and/or adapt for various applications such specific embodiments without departing from the generic concept, and, therefore, such adaptations and modifications should and are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments. It is to be understood that the phraseology or terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, those skilled in the art will recognize that the embodiments herein can be practiced with modification within the scope of the embodiments as described herein.

We Claim:

1) A structural study of traumatic optic neuropathy in head injury, the structural study is conducted on a total of 510 patients presenting with a head injury forexamination for all the ocular injuries;
- wherein the severity of the head injury is graded according to the Glasgow Coma Scale (GCS). wherein a computed tomography (CT) scan of the head is done in all the patients;
- wherein visually evoked potential (VEP) is done in patients who havea relative afferent pupillary defect (RAPD) and defective color vision; and
- wherein a diagnosis of traumatic optic neuropathy is confirmed on the basis of VEP.

2) The structural study as claimed in claim 1, wherein the majority of the people affected are males (77.5%).
3) The structural study as claimed in claim 1, wherein patients between 16-45 years are affected most.
4) The structural study as claimed in claim 1, wherein the most frequent site of injury is roadside (72.55%).
5) The structural study as claimed in claim 1, wherein ophthalmic involvement is observed in 313 individuals (61.4%).
6) The structural study as claimed in claim 1, wherein abnormal uni-ocular color vision is found in 21(4.11%) patients.
7) The structural study as claimed in claim 1, whereintheRAPD is found in 24 (4.70%) patients.
8) The structural study as claimed in claim 1, wherein the VEP is abnormal in 10 (1.96%) patients, of all the cases of head injury.
9) The structural study as claimed in claim 1, whereinthere is a 1.96% incidence of traumatic optic neuropathy in patients with a head injury.
10) The structural study as claimed in claim 1, wherein among all the ocular findings, eyelid
ecchymosis with edema is most common and wherein intracranial hemorrhage is the most common CT scan finding in head injury patients and wherein chances of ophthalmic manifestations are much more when there is intracranial bleeding and facial fractures.