Delayed Visual Recovery from Optic Nerve Injury Following a Procedure of Orbital Wall Reconstruction

Abstract

The acute onset of the vision loss by optic never injury following orbital wall reconstruction, has been reported in 0.5% - 5.0% of the cases. Visual impairment can be recovered within an early period after injury. Delayed visual recovery from optic nerve injury during a procedure of orbital wall reconstruction has not been reported. We report a case of delayed recovery from optic nerve injury which occurred following orbital wall reconstruction. A 78-year-old man underwent orbital wall reconstruction for medial wall fracture and resulting enophthalmos in the right eye, one week after a traffic accident. Immediate after surgery, postoperative visual acuity in the right eye decreased to light perception, and relative afferent pupillary defect (RAPD) was detected. In spite of mega-dose steroid treatment, the visual acuity did not improve. However, 8 months after surgery, visual acuity began to recover to 0.1, and the degree of RAPD decreased. Twelve months after surgery, visual acuity in the right eye was 0.4, and pupillary light reflex was normal. Our report suggests that patients with optic neuropathy by surgery or trauma require long-term follow-up, regardless of early response to mega-dose steroid treatment.