Microscopic intranasal decompression of the optic nerve.

We report our methods for using the surgical microscope to decompress the optic nerve intranasally and our results in five cases with optic nerve trauma, including a 7-year-old girl. Decompression seemed necessary in cases without canal fractures (four cases in the present report), since circular disturbances from edema may play a role in producing reversible visual impairments. The intranasal approach not only solved cosmetic problems associated with other techniques, but also provided better, less distorted views when compared with extranasal or transantral approaches. Microsurgery using a self-retaining retractor speculum resulted in improved visualization and reliable procedures during surgery. Since the operation does not impose a cosmetic or physical burden on patients, it can be done early when indicated to accelerate visual improvement following trauma.