Traumatic optic neuropathy in survivors of torture: two case reports and review of the literature

Introduction: Survivors of torture and violence may develop traumatic optic neuropathy after blunt cranio-orbital trauma incurred during torture, and diagnosis is often delayed by displacement and limited access to care. Case Presentations: Two survivors of torture with optic neuropathy were evaluated in a trauma-informed mobile eye clinic conducted between June 2023 and June 2024 in Toronto, Canada. Case 1 was a woman in her early 30s with 11 years of no light perception vision loss in the right eye that began immediately after blunt periocular trauma incurred during torture. Examination demonstrated a relative afferent pupillary defect (RAPD) and optic disc pallor; optical coherence tomography (OCT) showed marked retinal nerve fiber layer and macular thinning. Case 2 was a man in his early 30s with 4 years of right-sided vision loss that began immediately after blunt head trauma incurred during torture. He had reduced visual acuity, RAPD, and diminished color vision in the affected eye. OCT demonstrated diffuse retinal nerve fiber layer and ganglion cell complex thinning. Since neither patient underwent imaging at the time of injury, acute findings such as optic canal fracture, orbital fracture, or globe injury could not be assessed. Conclusion: These cases describe chronic traumatic optic neuropathy after torture-related blunt trauma and underscore the importance of trauma-informed ophthalmic screening and linkage to rehabilitation services for displaced survivors, particularly when acute injury records and imaging are unavailable.