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Ocular System

Optic nerve avulsion

Rare complication after ocular trauma with poor visual prognosis, characterised by separation of optic nerve from sclera by indirect forces due to relatively weak structure of the lamina cribrosa area.

Rare complication after ocular trauma with poor visual prognosis, characterised by separation of optic nerve from sclera by indirect forces due to relatively weak structure of the lamina cribrosa area.


Aetiology

Blunt/penetrating trauma

Through various indirect mechanisms the optic nerve may become detached at the lamina cribrosa, which is the weakest point, due to trauma-related sudden increase in intraocular pressure, sudden posterior displacement of the optic nerve, and strong rotation or anterior displacement of the globe.
  • Road traffic accidents
  • Sporting accidents
  • Falls
Ecchymosis of the upper and lower lids and laceration of the upper lid at presentation | Değirmenci, M., Yalçındağ, N., & Atilla, H. (2018). Optic Nerve Avulsion and Retinal Detachment After Penetrating Ocular Trauma: Case Report. Turkish journal of ophthalmology, 48(2), 89–91. https://doi.org/10.4274/tjo.31549

Complication

  • Vitreous haemorrhage (VH)

Diagnosis

Fundus examination:

  • excavation in the optic disc area
Fundus photograph in the right eye taken one day after the trauma | Değirmenci, M., Yalçındağ, N., & Atilla, H. (2018). Optic Nerve Avulsion and Retinal Detachment After Penetrating Ocular Trauma: Case Report. Turkish journal of ophthalmology, 48(2), 89–91. https://doi.org/10.4274/tjo.31549

CT scan/MRI:

Computed tomography image taken one day after the trauma showing discontinuity of the right optic nerve in the sclera at the point of entry to the globe | Değirmenci, M., Yalçındağ, N., & Atilla, H. (2018). Optic Nerve Avulsion and Retinal Detachment After Penetrating Ocular Trauma: Case Report. Turkish journal of ophthalmology, 48(2), 89–91. https://doi.org/10.4274/tjo.31549

Management

  • Steroid therapy
  • Vitrectomy

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