Traumatic optic nerve avulsion: A case report

Case report of a traumatic optic nerve avulsion.

We report the case of a traumatic right optic nerve avulsion in an 11-year-old boy as a result of a contusion with a surfboard. On initial examination, the patient exhibited bilateral mydriasis with a right afferent pupillary defect. Visual acuity was no light perception. A moderate microhyphema was noted along with intraocular pressure of 12mmHg and no open globe. Fundus examination revealed retinal ischemia with white retinal edema, attenuated arteries and segmentally occluded vasculature. In place of the optic nerve, there was a hole with associated vitreous hemorrhage. Non-contrast CT and MRI demonstrated vitreous prolapse into the optic nerve sheath, which still appeared securely attached to the globe. Spectral domain OCT and visual evoked potentials confirmed disruption of the ganglion cell layer.

While obvious in the presence of clear media, an avulsion may remain undetected in the case of associated vitreous hemorrhage. Orbital imaging may clarify the diagnosis.

Although rare, optic nerve avulsions exhibit the same risk profile as open globe injuries and arterial occlusions.