Optic nerve avulsion due to forced rotation of the globe by a snooker cue.

Abstract

We report a case ofpartial avulsion ofthe optic nerve caused by sudden rotation of the globe due to a snooker cue injury. Minimal direct ocular trauma occurred. This case supports the belief that sudden rotation of the globe is the major mechanism of optic nerve avulsion. We include the first results of ultrasound examination that demonstrate optic nerve injury in such a case and believe that, in conjunction with fluorescein angiography and computerised tomography, it is important in the full evaluation of such cases.

Papillopathie traumatique : à propos d’un cas d’arrachement partiel du nerf optique

“…Dans 49 % des cas, le traumatisme est dû à un petit objet intrusif [3], le plus souvent un doigt [4][5][6][7][8][9][10][11][12][13][14] et le basketball est le sport le plus pourvoyeur de ce type de traumatisme [4,8,12]. D'autres agents intrusifs peuvent être en cause : poignée de porte chez les enfants [15,16], bâton [6,15,17], club de golf [18], guidon de bicyclette [4,17] ou encore queue de billard [19]. L'avulsion du nerf optique peut aussi survenir suite à un traumatisme facial isolé : batte de cricket [20], coup de sabot de vache ou cheval [4], accident de la route [5,21,22] ou polytraumatisme [3,23] ainsi que dans des cas de traumatismes pénétrants du globe oculaire [16,24].…”

Failure of imaging to detect optic nerve avulsion: an explanation based on histopathology

“…Modern penetrating keratoplasty (PKP) can achieve better visual results than lamellar keratoplasty (LKP), and is less technically challenging and time consuming to perform. 4,5 LKP does, however, continue to have a role in tectonic surgery, and can be used as an alternative to PKP in countries where there is an absence of high-quality donor material, and in patients with increased risk of blunt ocular trauma.…”

“…3,4 Avulsion may be difficult to diagnose when the nerve head cannot be visualised on fundus examination. Additionally, imaging often does not reveal the diagnosis since the dural sheath remains attached to the globe.…”

Posterior Segment Manifestations of Closed-Globe Contusion Injury

“…[63][64][65][66][67][68] Patients typically describe a sudden loss of vision at the time of the trauma; the loss of vision may be severe or relatively minor. The avulsion is usually associated with other globe and orbital injuries but may occur as an isolated lesion.…”