An Unusual Presentation of Pediatric Orbital Trauma: Complete Optic Nerve Avulsion

Authors

  • Vítor Miranda Ophtalmology Department, Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal https://orcid.org/0000-0003-4480-5225
  • Catarina Pestana Aguiar Ophtalmology Department, Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal https://orcid.org/0000-0003-2487-4231
  • João Alves Ambrósio Ophtalmology Department, Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal https://orcid.org/0000-0003-2009-5126
  • João Chibante Pedro Ophtalmology Department, Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
  • Miguel Ruão Ophtalmology Department, Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
  • João Costa Ophtalmology Department, Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal

DOI:

https://doi.org/10.48560/rspo.31469

Keywords:

Child, Eye Injuries, Optic Nerve, Optic Nerve Injuries/diagnostic imaging, Optic Nerve Injuries/surgery

Abstract

Our aim is to describe a rare case of complete optic nerve avulsion in a pediatric patient following orbital blunt trauma and its follow-up with multimodal retinal imaging. An 8-year-old boy was admitted after sustaining blunt injury to his right orbital region with a door knob. Upon admission, he had periorbital hematoma, anisocoria, impaired eye movement and absence of light perception in the right eye. Fundus exam revealed sub-hyaloid and peripapillary haemorrhages with an absent optic disc, with a papillary “lacuna” in its place. Computed tomography imaging revealed several orbital fractures with entrapment and stretching of medial and inferior rectus muscles. The patient was managed conservatively and later submitted to reconstructive orbital surgery. There was no improvement in visual acuity six weeks after the trauma. Optic nerve avulsion is a rare complication of orbital trauma that leads to irreversible loss of visual function. In some cases, the diagnosis can be difficult initially due to media opacities.

Downloads

Download data is not yet available.

References

Buchwald HJ, Otte P, Lang GE. Evulsio nervi optici nach stumpfem Bulbustrauma–Fallbericht und Literaturübersicht Klin Monbl Augenheilkd. 2003;220:303–8. doi: 10.1055/s-2003-39425

Kashkouli MB, Yousefi S, Nojomi M, Sanjari MS, Pakdel F, Entezari M, et al. Traumatic optic neuropathy treatment trial (TONTT): open label, phase 3, multicenter, semi-experimental trial. Graefes Arch Clin Exp Ophthalmol. 2018;256:209–18. doi: 10.1007/s00417-017-3816-5.

Brodsky MC, Wald KJ, Chen S, Weiter JJ. Protracted posttraumatic optic disc swelling. Ophthalmology. 1995;102:1628–31. doi: 10.1016/s0161-6420(95)30817-2.

Frost WA. Trans Ophthal Soc U.K. 1903; 23:286.

Stanton-Cook L. Injury simulating congenital anomaly. Br J Ophthalmol. 1953;37:188–9. doi: 10.1136/bjo.37.3.188.

Park JH, Frenkel M, Dobbie JG, Choromokos E. Evulsion of the optic nerve. Am J Ophthalmol. 1971;72:969–71. doi: 10.1016/0002-9394(71)91699-0.

Schlenker T, Apenberg S, Raedsch R, Andrassy K, Plachky J, Kommerell B. Antineutrophile zytoplasmatische Antikörper bei chronisch-entzündlichen Darmerkrankungen. Dtsch Med Wochenschr. 1992;117:1463–8. doi: 10.1055/s-2008-1062465

Singh J, Goyal JL, Garg SP. Optic nerve avulsion following tipcat injury, fluorescein angiographic and echographic features. Afro-Asian J Ophthalmol. 1987;6:71–3.

Tsai HH, Jeng SF, Lin TS, Kueh NS, Hsieh CH. Predictive value of computed tomography in visual outcome in indirect traumatic optic neuropathy complicated with periorbital facial bone fracture. Clin Neurol Neurosurg. 2005;107:200–6. doi: 10.1016/j.clineuro.2004.07.015.

Lew H, Lee SY, Jang JW, Kim HY, Kang SJ, Kim SJ. The effects of high-dose corticosteroid therapy on optic nerve head blood flow in experimental traumatic optic neuropathy. Ophthalmic Res. 1999;31:463–70. doi: 10.1159/000055572.

Downloads

Published

2023-12-29

How to Cite

Miranda, V., Pestana Aguiar, C., Alves Ambrósio, J., Chibante Pedro, J., Ruão, M., & Costa, J. (2023). An Unusual Presentation of Pediatric Orbital Trauma: Complete Optic Nerve Avulsion. Revista Sociedade Portuguesa De Oftalmologia, 47(4), 294–297. https://doi.org/10.48560/rspo.31469

Issue

Section

Case Reports