title: A case series: bilateral ischemic optic neuropathy secondary to large volume fluid resuscitation in critically ill burn patients.
abstract: Ischemic optic neuropathy (ION) in the trauma setting is a rare and devastating condition associated with systemic hypotension, massive volume resuscitation, and sepsis. The objective of this case series is to highlight a potential correlation between severe burn and ischemic optic neuropathy. We present three patients with total body surface area (TBSA) thermal injury burns ranging from 57 to 68% treated at the North Carolina Jaycee Burn Center that developed bilateral ischemic optic neuropathy during their hospital stay. Each patient required greater than 25 L of crystalloid fluid within 24 h after admission, suffered multiple bouts of sepsis, and required extended pressor support. We postulate that ischemic optic neuropathy develops as a result of the interplay between the patient's systemic pathophysiology, i.e. shock, sepsis and the continued need for large volume fluid resuscitation. Current treatments of ION have not proven to be effective, except for possibly limiting fluid resuscitation. In the few cases of refractory burn shock, the incidence of this condition is unlikely to be readily improved. However, it is important for clinicians to be aware of this devastating complication and consider early ophthalmology involvement in the care of severely burned patients.
authors.affiliation: Johns Hopkins Department of Plastic Surgery, 601 N Caroline Street, Baltimore, MD 21205, United States; Division of Trauma, University of North Carolina School of Medicine, Doris Duke Research Fellow, 101 Manning Drive, Chapel Hill, NC 27514, United States.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Medina
authors.affiliation: Division of Trauma, University of North Carolina School of Medicine, T32 Trauma Research Fellow, 101 Manning Drive, Chapel Hill, NC 27514, United States.
authors.forename: Danier A
authors.initials: DA
authors.lastname: Moore
authors.affiliation: University of North Carolina School of Medicine, Director of North Carolina Jaycee Burn Center, 101 Manning Drive, Chapel Hill, NC 27514, United States. Electronic address: bruce_cairns@med.unc.edu.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000628:therapy*; D016638:Critical Illness; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000209:etiology*; D018805:Sepsis / Q000150:complications; D012769:Shock / Q000150:complications / Q000628:therapy*
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: Blindness; Burn; Ischemic optic neuropathy; Over resuscitation; Trauma