• Vol. 35 No. 3, 151–157
  • 15 March 2006

Hyperbaric Oxygen Therapy for Radiation-induced Optic Neuropathy

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ABSTRACT

Introduction: Radiation-induced optic neuropathy (RON) is an infrequent but devastating consequence of radiation exposure to the visual pathways, usually following months to years after the treatment of paranasal or intracranial tumours. Hyperbaric oxygen (HBO) therapy is one of several therapies that have been tried for this condition. The purpose of this review is to describe the clinical characteristics of RON, the rationale for the use of HBO in this condition, and the available clinical data on its safety and efficacy.

Methods: MEDLINE searches were performed on radiation optic neuropathy, hyperbaric oxygen therapy, and similar terms, and selected references were reviewed. The results were combined with the experience at our own institution.

Results: RON typically follows a fulminant course with characteristic symptoms, examination findings, and imaging. The threshold for prior radiation exposure depends upon the delivery system used and patient characteristics. Therapy with anticoagulants or steroids has been unsuccessful. While there are case reports in the literature of successful treatment with HBO, therapy with HBO has to be initiated soon after the onset of vision loss, and even then yields variable results at best.

Conclusions: There is still no consistently successful treatment for RON. HBO may be attempted in selected cases, but the prognosis for preservation of vision remains grim.


Radiation optic neuropathy (RON) is an infrequent but usually devastating consequence of radiation to the optic pathways. It is almost exclusively an iatrogenic phenomenon, occurring in patients who have undergone radiation therapy for tumours and other lesions in sites near the visual apparatus, such as the choroid, orbit, paranasal sinuses, nasal cavity and cranial fossae.

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