Traumatic optic nerve avulsion by high caliber bullet: case report

Traumatic optic nerve avulsion occurs most commonly after blunt ocular trauma. Optic nerve avulsion by high caliber bullet is exceptional and must be thought of in the management of those patients victims of gunshot wounds to the globe and orbit. The present paper reports the first documented case of this singular condition of optic nerve injury and comments on several other related causes, pathophysiology mechanisms, histology and management.     

Optic nerve head avulsion: a case report

Optic nerve head avulsion is a rare condition. It consists in a rupture of the nerve fibers at the level of the lamina cribrosa followed by a retraction of these fibers into the intact optic sheath. We report a case of optic nerve head avulsion following globe contusion. The association of a sudden forced globe rotation, a possible acute proptosis, and a sudden rise in intraocular pressure likely caused the avulsion. The presence of intraocular hemorrhages did not prevent examination of the optic nerve head region, which showed a crater. Initial visual acuity was no light perception. An orbit bone fracture was ruled out after CT examination. The patient was treated with general antibiotics and eyedrops (antibiotic/corticosteroid and atropine). No visual recovery was observed.     

Functional and structural analysis of partial optic nerve avulsion due to blunt trauma: case report

Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury.     

Ultrasonography in optic nerve head avulsion

The diagnosis of post traumatic optic nerve avulsion is often obscured by the presence of concomitant vitreous haemorrhage. Electrodiagnostic tests, CT scan and fluorescein angiography have not proved helpful in substantiating the diagnosis of this entity in the early stages. We herein present the echographic features in a case of post traumatic optic nerve avulsion that, to the best of our knowledge, have not been previously described. The role of ultrasonography in the diagnosis of suspected optic nerve head avulsion has been high-lighted.     

Self-inflicted repetitive optic nerve injury: a case report

PURPOSE: To describe an obsessive-compulsive patient who developed blindness after self-inflicted repetitive optic nerve injury. METHODS: Case report. RESULTS: A myopic 46-year-old male became blind as a result of intermittent rubbing of his eyes, causing stretching of the optic nerves. Extensive ocular, neurologic and systemic work-ups were negative. Cerebral and orbital MR studies showed severe bilateral optic nerve atrophy. Psychiatric evaluation confirmed obsessive-compulsive personality. CONCLUSIONS: Self-inflicted optic nerve injury should be included in the differential diagnosis of progressive optic neuropathy in a young adult.     

Traumatic avulsion of the optic nerve.

Avulsion of the optic nerve is an infrequent traumatic event which results in a permanent and usually devastating loss of vision. We present two cases which highlight the salient features of partial and complete optic nerve avulsion. The clinical findings, including the results of B-scan ultrasonography, fluorescein angiography, and computed tomography (CT) are discussed. In addition, the past two decades of literature pertaining to optic nerve avulsion are reviewed and summarized.     

Computer tomography in partial optic nerve avulsion

An partial avulsion of the optic nerve was found after a blunt ocular trauma in a 34-year old-patient. For the first time it is possible to demonstrate CT exposures of such a case. The importance of this method in cases of blunt ocular trauma accompanied by hemorrhages of the anterior chamber or the vitreous is discussed.     

Arachnoid cyst of the optic nerve: a case report

BACKGROUND: To report a case of an arachnoid cyst of the optic nerve with homonymous optic atrophy. HISTORY AND SIGNS: A 17-year-old female patient presented with severe visual loss, limited to light perception, of the left eye. She underwent complete ophthalmologic examination, color fundus photography and electrophysiological study. Magnetic resonance imaging (MRI) revealed the presence of a fusiform structure involving the left optic nerve from the orbital apex to the posterior surface of the globe. The clinical and radiographic features are consistent with an arachnoid cyst of the optic nerve. THERAPY AND OUTCOME: The patient refused to be treated. Two years later, the VA remained unchanged. CONCLUSIONS: The arachnoid cyst of the optic nerve is a rare entity. Its differential diagnosis from the primary optic nerve glioma is difficult and important to be made in order to be treated properly.     

Optical coherence tomography in optic nerve head avulsion

Early diagnosis of optic nerve head (ONH) avulsion may be difficult due to an obscured fundus view. Although B-scan ultrasonography is more useful than MRI and CT imaging, it has limited sensitivity and specificity. Optical coherence tomography (OCT) can be used to identify optic nerve pathology. Utilization of OCT has not been widely reported in the diagnosis of ONH avulsion. Two cases OCT use in ONH avulsion are reported. The utility of OCT in the diagnosis of ONH avulsion is of limited value.     

Retrobulbar optic nerve cysticercosis with surgical removal: a case report

A 15-year-old boy presented with diminution of vision which rapidly progressed to no perception of light. In the ocular fundus, a neuroretinitis-like picture was seen. On CT-scan & ultrasonography, an optic nerve swelling was detected with a shadow of scolex. Medical therapy in the form of steroids along with albendazole was ineffective. Surgical removal by lateral orbitotomy was done and a complete cyst with scolex was removed, which was confirmed histopathologically as a case of retrobulbar optic nerve cysticercosis.     

Retrobulbar optic nerve cysticercosis with surgical removal: a case report

A 15-year-old boy presented with diminution of vision which rapidly progressed to no perception of light. In the ocular fundus, a neuroretinitis-like picture was seen. On CT-scan & ultrasonography, an optic nerve swelling was detected with a shadow of scolex. Medical therapy in the form of steroids along with albendazole was ineffective. Surgical removal by lateral orbitotomy was done and a complete cyst with scolex was removed, which was confirmed histopathologically as a case of retrobulbar optic nerve cysticercosis.     

Monocular fixation with the optic nerve head: a case report.

PURPOSE: To document and discuss the case of a patient with left esotropia (ET) who uses the left optic nerve head (ONH) for monocular 'fixation'. CASE REPORT: The patient was an 80-year-old male with left ET from early childhood. Retinal tracking monocular fixation measurements with a Nidek MP-1 revealed stable fixation within the left ONH area. In an attempt to challenge the initial observation, further assessments of fixation were performed with a smaller target size and requiring various gaze positions. MP-1 fixation data showed remarkably stable monocular fixation (+/-1 degrees over 30 s) mostly within the left ONH for all the target sizes and positions of gaze tested. Additional clinical binocular evaluations showed concomitant left ET approximately 28 Delta, no movement with cover test regardless of fixation target and no significant monocular motility restrictions. Visuoscopy also revealed fixation at the left ONH. There was a strong family history of ET, but none of the other affected descendants tested (n = 3) demonstrated the same behaviour. CONCLUSIONS: This is the first report documenting an abnormally developed monocular ocular motor system, with principal visual direction and zero retinomotor value shifted from the fovea to the ONH. We do not believe that there is any direct visual input from the ONH. The patient may use visual information obtained by glancing with peri-papillary areas to determine the target position (although this was largely ruled out), or obtain position information from the average luminance produced by scattered light around the ONH margin. The abnormal oculocentric direction might then be combined with extraretinal information (efferent copy or extraocular muscle proprioception) of the eye location in the orbit to stabilize the fixation. This patient does not have the blind spot syndrome (Swan, 1948). We propose the use of a retinal perimeter for documentation of eccentric fixation in strabismus.     

Conservative treatment of post-traumatic lesion of the optic nerve

Twenty one patients aged 18-77 years with a lesion of the optic nerve caused by contusion of the head were treated conservatively in the period 1980-87. An improvement--often a substantial one--of the visual acuity was attained in 52.3 p.c. of patients; in 17 patients the vision did not deteriorate in the period of control examinations.