Optic nerve avulsion following accidental penetrating orbital injury

Traumatic enucleation with optic nerve avulsion following accidental penetrating orbital injury is a rare phenomenon. A 35 years old young active man was suddenly traumatized in his left orbit after falling down on a boat following collision of two running boats having no search light in a dark night. The patient was examined few hours after the event. The patient presented with severe pain around left periorbital region. He never lost consciousness. On examination right eye revealed no abnormality. There was left periorbital swelling with blood clots. Left eyeball was hanging from the orbit with 20mm portion of optic nerve. Left eyeball was suspended with the attachment of superior oblique, superior rectus, inferior rectus, lateral rectus muscle. Medial rectus was lacerated and could not be traced out. One V shaped lacerated injury over the root of left side of nose was noted. One arm of the injury caused full thickness laceration of upper lid and other arm entered within orbit with medial bony orbital wall in nasal side and periorbita with other structures in temporal side upto apex of the orbit. Another lacerated full thickness lower lid injury was also noted. This case was managed surgically by removal of the left eyeball with orbital implant. Conjunctival injury, upper and lower lid injuries were repaired after proper surgical toileting. Ocular prosthesis was given two weeks later to have a good cosmetic view. Postoperatively the patient was managed with systemic antibiotics, NSAIDS and topical antibiotics. Traumatic enucleation following accidental boat collision was not reported yet. Awareness of the passengers, strict maintenance of the navigation rules may prevent this type of hazards.