Optic nerve avulsion: Case report

Area of Science:

• Ophthalmology
• Trauma Surgery
• Medical Imaging

Background:

• Optic nerve avulsion (ONA) is a rare but severe complication of blunt ocular trauma, involving traumatic disinsertion of optic nerve fibers.
• It is often challenging to diagnose initially due to significant hemorrhage obscuring the optic disc.

Observation:

• A 15-year-old male sustained ONA after being kicked by a horse, presenting with eyelid hematoma and vision limited to light perception.
• Initial examination revealed extensive vitreous and preretinal hemorrhage, along with optic disc edema.
• Five years post-injury, the patient showed optic disc dragging, fibroglial scarring, and retinal vascular changes.

Findings:

• Initial diagnosis of ONA was confirmed despite media opacities.
• Multimodal imaging can aid in diagnosing ONA and assessing associated ocular damage.
• The healing process involves fibroglial proliferation, and visual outcomes are generally poor, ranging from light perception to no light perception.

Implications:

• ONA is a severe condition with a poor prognosis, often resulting in permanent visual impairment.
• Early and accurate diagnosis, potentially aided by advanced imaging, is crucial for managing ONA.
• Understanding the long-term sequelae, such as fibroglial scarring, is important for patient management and counseling.