Traumatic optic nerve injury occurring after forceps delivery of a term newborn.

Abstract

Forceps were used to assist the delivery of a healthy full-term boy. 1 He suffered a medial left lower eyelid laceration involving the lacrimal drainage system that was repaired on his first day of life. He also had peripapillary and severe retinal hemorrhages in the left eye. The infant’s pupil had been dilated before the ophthalmologist’s arrival; thus, a left-relative afferent pupillary defect was noted only on subsequent examinations. Optic nerve pallor with peripapillary pigmentary changes developed, consistent with traumatic optic nerve injury. Numerous complications of forceps delivery have been reported, including seventh cranial nerve palsy, lid ecchymosis, corneal edema, often with breaks in Descemet’s membrane, corneal abscess, traumatic hyphema, Purtscher’s retinopathy 2 , choroidal ruptures 3 , and traumatic optic neuropathy with complex abnormalities seen on computed axial tomography (CAT). 4 The medial portion of the eyelid, including the canalicular system, is unusually vulnerable when any blunt lower eyelid trauma occurs. 5 Sudden traumatic rotation of the globe during forceps delivery is the likely mechanism of injury to the left optic nerve in the absence of fractures of the orbit or optic canal. 6 This is the first case report of traumatic optic nerve injury caused by forceps injury to the medial portion of the orbit without any CAT abnormalities.