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

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.