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

Borel, Anne‐Laure; Bonnin, N.; Porte, Catherine; Chiambaretta, F.; Bacin, F

doi:10.1016/j.jfo.2012.08.003

Cited by 9 publications

(3 citation statements)

References 27 publications

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“…Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation [ 10 ]. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Optic nerve avulsion: Case report

Mahjoub

Sellem

Abdesslem

et al. 2021

Annals of Medicine &Amp; Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

“…Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA [ 11 ]. As to the management, procedures that have been proposed were optic nerve fenestration, corticosteroid and watchful surveillance but there was no difference between different procedures in term of final VA [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Optic nerve avulsion: Case report

Mahjoub

Sellem

Abdesslem

et al. 2021

Annals of Medicine &Amp; Surgery

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“…The visual prognosis for ONA and CRAO is that devastating. In total traumatic ONA, the visual prognosis is very dismal and the nal visual outcome usually ranges from light perception to NLP 21 . A series of 14 children with traumatic ONA resulted from door handle injuries were analyzed that the nal visual outcome was light perception only in 1 patient 22 .…”

Section: Disscusionmentioning

confidence: 99%

Traumatic optic nerve avulsion and CRAO after gouging injury

Zhou,

2024

Preprint

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Purpose: This case report gives more attention to potential risky blindness, as the complication of gouging injury. The visual prognosis of traumatic ocular injuries varies so much. Optic nerve avulsion and central retinal artery occlusion (CRAO) are the most severe one with a grave prognosis, which was rarely described in the previous reports. In this rare case, Optic nerve avulsion and CRAO concurred after finger gouging by someone else. Case report: A 22-year-old girl complained of visual damage in the left eye after finger gouging. On her first visit to our emergent center, her visual acuity was confirmed to be no light perception in the left eye, with normal intraocular pressure and quite anterior chamber. Slit-lamp examination revealed remarkable relative afferent pupil defect (RAPD) in the left eye. Fundus examination of left eye revealed hemorrhages around optic papilla, vitreous hemorrhage in the inferior vitreous cavity, white granular substance both in the front of the optic papilla and in the inferior vitreous cavity, retinal opacification at the macula area associated with segmentation of blood column. Optical coherence tomography demonstrated the missing of superior temporal quadrant of the optic papilla, thick fiber layer of the optic nerve, the intruding vitreous body prolapse into optic nerve sheath, and edema of the inner retina. Fundus fluorescein angiography showed the presence of cilioretinal artery, the delayed filling of central retinal artery, and blockage of fluorescence by preretinal hemorrhage in the left eye. Neither optic canal nor optic nerve sheath was observer to be discontinued on computed tomography. All these findings indicated that optic nerve avulsion and CRAO had occurred. We performed implosive high-dose intravenous corticosteroid therapy, but the response was not very well, without improvement of her visual acuity. Six months later, the visual acuity in her left eye was unchanged, and gliosis developed at the avulsion site. Conclusion: The concurrent diagnosis of traumatic ONA and CRAO is such rare and severe, and the first sight diagnosis is very challenging. OCT and FFA can provide early diagnosis of traumatic ONA and CRAO. The prognosis of traumatic ONA and CRAO is very poor, even though with large dosage of steroid, the injuries will lead to permanent visual loss. This case highlighted the on-call ophthalmologist’s awareness of ONA and CRAO after gouging injury.

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