SMACH: A Rare, Non-Progressive Retinal Disorder - Key Insights into Its Clinical and Imaging Characteristics. A Case Report.

Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma, occurring in approximately 0.7-2.5% of head injury cases []. It involves injury to the optic nerve from direct or indirect trauma to the orbit or skull, often resulting in partial or complete vision loss. Clinical features include ipsilateral vision impairment, color vision changes, pupillary defects, visual field deficits, and, in severe cases, relative afferent pupillary defect (RAPD) [,]. Common causes include falls, motor vehicle accidents, and physical assaults [,]. TON can be classified as direct or indirect. Direct TON typically results from bony fragment impingement or optic nerve contusion, often causing complete vision loss and a poorer prognosis. Indirect TON preserves anatomical continuity, allowing greater potential for visual recovery [,]. No universally accepted treatment protocol exists due to uncertainty regarding optimal timing and approach []. Surgical decompression of the optic canal can relieve pressure from hematomas or edema, potentially improving visual outcomes [,]. The principles of optic nerve decompression have also been studied in optic nerve compression caused by tumors, showing that relieving mechanical pressure is critical to preserving vision [].