Optic nerve avulsion: Case report

Abstract

Introduction Optic nerve avulsion is a traumatic disinsertion of optic nerve fibres from the globe at the level of the lamina cribrosa. It is an uncommon and severe complication of blunt ocular trauma. Case presentation We report the case of a 15 years old male presented to the emergency department after being kicked by a horse. Initial ophthalmologic examination of the left eye (LE), exhibited eyelid hematoma, subconjunctival hemorrhage, VA was limited to light perception and there was a left relative afferent pupillary defect. Dilated fundus examination of the LE revealed an extensive vitreous and preretinal hemorrhage overlaying the optic disc and retina edema.The diagnosis of LE optic nerve head avulsion (ONA) was made. Five years after the accident, VA of LE detecting hand motion, fundus examination revealed a superior dragging of the optic disc, fibroglial scarring, retinal vessel narrowing and retinal epithelium hyperplasia. Clinical discussion In case of ONA, the avulsion can be missed initially due to vitreous and retinal hemorrhage overlaying the optic nerve, in such cases multimodal imaging can be a useful tool to the diagnosis and to evaluate associated ocular damage. Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA. Conclusion Optic head nerve avulsion is a rare and severe disease and initial diagnosis is challenging due to associated media opacities. The prognosis is poor and the injury leads to permanent visual impairment.

The effect of a proposed training curriculum on different punching distances and some kinematic variables for junior boxers

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Optic Nerve Avulsion: Pattern and Etiologies at a Tertiary Eye Care Center in Saudi Arabia: An 8-Year Retrospective Study

“…9 Various hypotheses of ONA have been proposed, including severe forced rotation of the globe, which avulses the optic nerve from a weakened scleral region, and a sudden elevation in intraocular pressure induced by compression of the globe or by abrupt forward propulsion of the globe as a result of increased intraorbital pressure, producing rupture at the weaker lamina cribrosa. 8,10,11 There are several potential causes of ONA including blunt trauma, road traffic accident (RTA), or autoenucleation in psychiatric patients. [12][13][14] ONA has been observed from sports injuries in children, falls, and door handle trauma.…”