Optic Nerve Avulsion Research Articles

Ocular problems among divers: a systematic review

Background: Scuba diving has been associated with various ocular conditions, affecting divers of all skill levels, from beginners to experienced individuals. Barotrauma, often caused by mask squeeze, is a well-documented issue in diving. Understanding the common eye problems divers encounter is crucial to ensure divers can take necessary precautions and safeguard the health of their eyes during and after dives. We conducted a systematic review to evaluate the various ocular problems that divers may face, explore their underlying causes, discuss preventive measures, and outline potential treatments. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) from the PubMed and Cochrane Library databases. Study quality and risk of bias were assessed using a checklist from Joanna Briggs Institute (JBI). Results: We included 10 kinds of literature from all over the world, mostly originating in the United States region. The most common ocular problems are subconjunctival hemorrhage, proptosis, periorbital swelling and ecchymoses, and diplopia. More serious cases, such as intraorbital hemorrhage, proptosis, central retina artery occlusion, and optic nerve avulsion, were also reported. Conclusions: Understanding and addressing divers' ocular problems is essential to protecting their eye health and enhancing their diving experience. By implementing preventive measures, divers can effectively mitigate the risks and promote the overall well-being of their eyes while immersing themselves in the wonders of the underwater world.

Pediatric ocular trauma: insights from a tertiary care hospital in Northern India

Background Childhood ocular trauma has major consequences since it can lead to lifelong blindness and visual impairment. Purpose The aim of this study was to assess the burden of pediatric ocular trauma and to identify its important determinants. Patients and methods This prospective study included all individuals (N=124) less than 18 years old who experienced eye injuries and sought treatment at the Outpatient or Emergency Services of the Department of Ophthalmology, Government Medical College, Jammu, India. The collected data included a detailed history of the injury, including systemic factors. The demographic and clinical information, such as age, sex, urban or rural residence, injury date and time, and previous treatments were also recorded. Results A total of 523 children (0–18 years old) with a mean age of 10.96±0.24 years were included in the study. Among these, 124 (23.71%) children with a mean age of 9.86±1.23 years had ocular injuries. The highest incidence of ocular trauma (68.54%) was observed in the 6–12-year-old age group. Boys accounted for the majority of cases (74.19%), and rural children were disproportionately affected (69.35%). Open globe injuries were more prevalent (62.9%) than closed globe injuries (25.0%). Perforating corneal injuries were the most common type of open globe injury (70.51%), while bat/ball injuries (38.70%) and falls (22.58%) were the leading causes of closed globe injuries. Zone I injuries were the most frequent location for both open and closed globe injuries. The Ocular Trauma Score was used to predict the injury severity, demonstrating an accuracy of 80%. The visual acuity data were available for 63 (57.79%) children at the initial presentation. Among these, 14 (22.22%) had no light perception, 23 (36.51%) had light perception, and 26 (41.27%) demonstrated a best-corrected visual acuity of 0.2±0.1 (0.1–0.3). At the final follow up at 6 months, five (7.94%) eyes experienced a vision of no light perception attributed to optic nerve avulsion, one (1.59%) eye retained light perception, two (3.17%) eyes demonstrated counting fingers acuity, and 55 (87.3%) eyes achieved a best-corrected visual acuity of 0.8±0.6 (range: 0.8 to ≥0.9). Conclusion The current study highlighted the substantial impact of pediatric ocular trauma, with a focus on open globe injuries and prevalent risk factors. The observed improvement in visual acuity underscores the significance of timely intervention, yet the 7.94% incidence of monocular blindness signals the ongoing need for targeted prevention strategies in this vulnerable population.

Central retinal artery occlusion following pediatric blunt ocular trauma.

To analyze the clinical profile, presentation, possible pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects. The medical charts of subjects aged 18 years or less with a diagnosis of CRAO following blunt ocular trauma were analyzed retrospectively for demography, details of the trauma, ocular findings, additional imaging reports if any, and final outcome. A Medline search was done (key words like central retinal artery occlusion, blunt trauma, children, pediatric subjects, and adolescents) to gather information available in the literature on the subject. A total of 11 patients (11 eyes), mean age of 14.3 ± 3.4 years, and 100% male preponderance, with an average time duration from trauma to presentation to the hospital of 8.1 days were included. Visual acuity ranged from no light perception (four eyes) to finger count at a 1 m distance. Intraocular pressure was raised in three patients, of which two were suffering from sickle cell disease. In two eyes, the CRAO coexisted with optic nerve avulsion and the cilioretinal artery was spared. Disk pallor was seen in six eyes as early as 12 days from the trauma. None of the cases revealed any bony fracture in the CT scan. CRAO was observed to be an important primary or contributory cause of visual loss in children following blunt trauma, reflex vasospasm being the most common etiology. Early onset disk pallor could suggest an underlying vascular compromise of both retinal and optic disk circulation in addition to direct disk damage.

Optic Nerve Avulsion: Pattern and Etiologies at a Tertiary Eye Care Center in Saudi Arabia: An 8-Year Retrospective Study.

Optic nerve avulsion (ONA) is a rare but serious presentation of ocular trauma. This study investigates the presenting characteristics and etiologies of all cases of ONA over an 8-year-period at a tertiary eye care center in the Middle East. The medical records of patients diagnosed with ONA at an Ophthalmic Emergency Department between November 2014 and November 2022 were analyzed in this retrospective cohort study. Data were collected on patient age, sex, affected eye, cause of injury and imaging studies. The best-corrected visual acuity (BCVA) at presentation and at the last follow-up visit, and the duration of follow-up were documented. The study sample was comprised of 44 eyes of 43 patients with ONA with median age of 16.5 (9.3-26.8) years ranging from 2 years old to 70 years old. There were (35;79.5%) males and (9; 20.5%) females. Most cases presented with an affected left eye (27; 61.4%) followed by the right eye (16; 36.4%) and only one patient (2.3%) had bilateral ONA. The most common cause of trauma resulting in ONA was a metallic object (8;18.2%). This study demonstrates the value of multi-sequence Magnetic resonance imaging (MRI) in the setting of unexplained vision loss when other modalities are inadequate or inconclusive. Ophthalmic morbidity resulting from ONA can be devastating. Metallic object injuries were the most prevalent cause of ONA. The presence of associated media opacities challenges the initial diagnosis of ONA. In the vast majority of cases, the vision ended as no light perception (NLP), indicating permanent vision impairment.

Ultrasonography in ocular trauma: A pictorial description

Ultrasonography is an indispensable diagnostic tool for examination of the eye after ocular trauma, which can be quite challenging due to various reasons like lack of patient cooperation, hazy media, and injury to periocular structures. We have retrospectively analyzed the case records of 269 patients who had sustained ocular trauma over a span of 1 year and compiled the data of the findings that were obtained from ultrasound scan. The scan was found to be normal in most cases (27.63%) and the second most common finding was retinal detachment (24.36%). Other findings that were noted are vitreous hemorrhage, choroidal detachment, optic nerve avulsion, endophthalmitis, panophthalmitis, presence of intraocular foreign body, and phthisis bulbi.

Case Series of Ocular Injury with Firecracker During Diwali in North India

Objectives:- The primary aim of this case series is to evaluate and report the patients presenting at a tertiary care hospital with an ocular injury sustained due to firecrackers during the occasion of the Diwali festival and to report the pattern and severity of firecrackers associated ocular injury and to what extent this affects the visual acuity of these patients.
 Methods:- This study is a tertiary care teaching hospital-based prospective study that includes 14 eyes of 12 patients who suffered firecracker-associated ocular injuries. All of them were presented to the hospital’s emergency department within one week after the Diwali festival. A detailed history of all the patients was taken and their ocular examination was done. Out of 12 patients, 7 were admitted for further surgical management, and one patient who sustained a superficial facial burn, including periorbital area, without any eye injury was admitted to the department of plastic surgery 4 patients were given conservative treatment. The injuries were classified according to the ocular trauma scoring system (OTSS).
 Results:- Out of the 12 patients presented, all were males, all of age group 6 years to 42 years (mean age group 18 years). Eight of them sustained injuries from explosive firecrackers and four sustained injuries from bottle rockets. Six of them were involved in igniting firecrackers, while 5 patients were either bystanders or passersby. Out of 11 patients, the right eye (RE) was involved in 6, the Left eye (LE) was involved in 4 and both eyes (BE) were engaged in 1 patient. Out of 12 eyes, six eyes had open globe perforating injuries involving cornea or cornea and sclera both, two eyes had mild conjunctival congestion and superficial burn over the periorbital region, one eye had conjunctival injury and one eye had a vitreous hemorrhage, one eye had traumatic retinal detachment, one eye had optic nerve avulsion. The maximum number of affected eyes falls under OTSS score II, indicating poor prognosis regarding visual acuity.
 Conclusion:- Firecrackers may cause injuries in one or both eyes which may be grievous in nature resulting in an irreversible loss of vision in either or both eyes. Hence, it is a matter of serious concern. Directives should be formulated to register the ocular injury presented to the hospitals. The public should be educated regarding the safe handling of firecrackers. Firecracker manufacturing companies should be instructed to manufacture less explosive and safer firecrackers.

Endoscopic Optic Nerve Decompression for Direct Traumatic Optic Neuropathy : Our 10 Years Experience.

Traumatic optic neuropathy (TON) can be classified into direct or indirect types. Direct optic injury usually results from optic nerve avulsion ,laceration or compression by fracture, fracture segment impingement or a resultant hematoma. Indirect optic injury is caused by increased intracanalicular pressure resulting in ischemia and disruption of neurofeedback channels. The prognosis of TON is usually quite poor. To date, no standardized treatment protocol has been developed for TON. In this study we are assessing the visual improvement in patients with direct TON who underwent endoscopic optic nerve decompression in the last 10 years. A retrospective study of 32 cases of optic nerve decompression for direct TON in the last 10 years. Preoperative and postoperative visual assessment were done and followed up for 3 months. There was complete improvement in vision in 17% of patients when optic nerve decompression was done within 72h of trauma; whereas 31% cases had only partial improvement when done between 3 and 7 days. And there was no improvement when done after 7 days. Endoscopic optic nerve decompression is a minimally invasive surgery for direct traumatic optic neuropathy; with minimal or no complications when done by an experienced ENT surgeon. Other important prognostic factors include timing of surgery and preoperative visual status.

Surfboard Related Orbital and Periocular Injury.

The objective of this study is to present the complexity of surfboard related orbital and periocular injuries and to discuss the different prevention aspects of such injuries. A retrospective review was performed on surfing related orbital and periocular injuries cases in a single tertiary medical center over a period of 10 years. Six patients at a mean age of 34 (range 20-50) years were evaluated. All were amateur surfers. Five patients had an orbital fracture, 3 had a full thickness eyelid laceration, 3 had lacrimal drainage system damage and 3 had intraocular findings related to trauma, but no perforation of the globe was observed. Two patients had complete optic nerve avulsion or transection, 1 of them had extraocular muscle transection. Five patients underwent surgery and 2 required an additional surgical intervention. At the end of follow-up, 3 patients had an unrepairable lacrimal drainage damage, 2 had a malposition of an eyelid, 2 eyes remained blind, 1 patient had a hypoglobus, and 1 had hypoesthesia in distribution of infraorbital nerve. Surfboard related orbital injuries may cause a severe orbital injury, which may debilitate and disable a previously active and healthy group of young people. Hence, protective gear wear should be more vigorously encouraged as already been done in other sports.

Traumatic optic neuropathy with concealed CRAO following blunt trauma in a young male patient: A rare case report

Traumatic Optic Neuropathy (TON) is a condition which results from vulnerable nature of the optic nerve to direct and indirect trauma leading to functional impairment of vision. Several varieties of direct optic nerve injury may be identified: optic nerve avulsion, transection, optic nerve sheath haemorrhage, orbital haemorrhage, and orbital emphysema. Central retinal artery occlusion (CRAO) is the sudden blockage of the central retinal artery, resulting in retinal hypoperfusion, leading to rapidly progressive cellular damage, and vision loss. An embolism is the most common cause of CRAO. The degree of collateralization and the duration of retinal ischemia determines the retinal survival. There are only few reported cases of central retinal artery occlusion caused by blunt traumaWe report a case of traumatic optic neuropathy presenting along with central retinal artery occlusion following a high speed blunt trauma to eye in an otherwise healthy young male.

The Utility of Ocular Imaging in Traumatic Optic Nerve Avulsion: A Case Report

Objective: To describe a detailed presentation and the utility of ocular imaging, both ocular ultrasound and orbital computed tomography (CT), to confirm the diagnosis of traumatic ONA in which megadose steroid would give no advantage. Case Presentation: A five-year-old boy came with a unilateral sudden visual loss after incidentally falling with his left eye struck to a handlebar of a parked bicycle. His left eye had no light perception, ophthalmoplegia, and showing 4+ relative afferent pupillary defect. A hallmark "pit" sign and a pale retina without a tear were noted. B-scan ocular ultrasound displayed retinal step sign, vitreous hemorrhage in front of the optic canal, lamina cribrosa defect, edematous retina, and retracted optic nerve. Orbital computed tomography scan showed a disruption of the optic nerve-globe junction. Steroid infusion was decided not to be given. Conclusion: Ocular imaging, especially ultrasound, along with a thorough examination, is satisfactorily adequate to confirm the diagnosis of traumatic ONA.

Role of B-scan in management of ocular trauma

The present study aimed to study the effectiveness of B scan in assessing the posterior segment in patients with ocular trauma, so that further treatment plan can be decided and prognosis can be improved. The study was conducted as a cross-sectional study at tertiary care centre during the study period of 1 year on 42 patients presenting with history of ocular trauma. Patients were subjected to detailed history and ocular examination followed by B scan ultrasonography for ruling out posterior segment pathology. Mean age of 42.7±20.2 years and 45.2% patients belonged to 41 to 60 years of age. About 54.8% cases were females. About 50% cases had one or the other posterior segment finding. Retinal detachment followed by vitreous hemorrhage were the most common findings, observed in 19% and 11.9% cases respectively. Avulsion of optic nerve was the least common finding (2.4%). B scan ultrasonography plays an important role in management of patients with ocular trauma for the detection of hidden posterior segment lesions. B scan must be performed routinely in all the cases of ocular trauma for early diagnosis and appropriate management of each case and to reduce the ocular morbidities.

Traumatic optic nerve avulsion in indoor sport

Optic nerve head avulsion is a rare complication of ocular blunt trauma usually seen in outdoor sport. The case reported is a 19-year old male presented due to sudden loss of vision in right eye following injury by jumped off dice while playing carom board. On examination visual acuity was light perception and fundus showed vitreous hemorrhage and deep seated optic nerve head. As visual recovery was unlikely, he advised to follow up after one month after explaining prognosis. We emphasis to suspect optic nerve avulsion in indoor sport injury and early diagnosis to prevent unnecessary treatment.

Dramatic traumatic optic neuropathy: A rare entity

Traumatic optic nerve (ON) avulsion corresponds to the disinsertion of the ON from the eyeball at the level of the lamina cribrosa. We report clinical and multimodal imaging findings in partial (ON) avulsion following head trauma.

An Optic Nerve Avulsion Due to A Gun Shot Injury: A Case Report

Purpose: To present a rare case of optic nerve avulsion due to gun shot injury. Case Report: A 30-year-old man presented with sudden visual loss on the Right Eye (RE) after a gun shot on his left frontal bone. On examination of the RE, he had periorbital hematoma and edema, and also conjunctival chemosis. There was no light perception of the RE, and his pupil was dilated and nonreactive to light. There’s also an eye movement resistance. On the examination of the Left Eye, he had periorbital hematoma and edema, visual acuity was 1.0 and other examinations was within normal limit. B-scan USG of the RE showed a hyperechoic image on the retinal projection in front of the optic nerve. CT-scan showed multiple metal density fractions in the subcortical cortical left frontal lobe and right retrobulbar. On funduscopic examination, there was bleeding in the inferior vitreous originating from the optic nerve papilae. The patient underwent craniotomy, debridement, and corpus alienum extraction by neurosurgeon and plastic surgeon. The patient was treated with high dose steroid (methyl prednisolone 4 x 250 mg iv). After a week of therapy, there was no improvement of his RE visual acuity. Conclusion: Optic nerve avulsion is a rare case with devastating results because there’s still no definite therapy to improve the outcome.

Optic nerve avulsion: A case report

AbstractA case of a 13-year-old girl after being injured on the left eyeball by a stick from a cage, is presented. Along vitreous haemorrhage, retinal oedema and ischaemia, the disc was replaced by a cavity. Multimodal imaging was performed, which confirmed the optic nerve damage. The eye had no light perception anymore. Our case is a demonstration for complete avulsion of the optic nerve after blunt injury.

Clinical characteristics and outcomes of ocular injuries in pediatric patients.

Childhood eye injuries are one of the most common causes of acquired unilateral blindness. In this study, our purpose was to investigate the demographics, etiology, and outcome of pediatric patients with ocular injury. The charts of children with ocular trauma who presented to Baskent University Hospitals, between January 1, 2017 and December 31, 2019 were retrospectively reviewed. All patients who were under 16 years of age were included. Data were collected on age, sex, time of trauma, injury type, associated injuries, treatments, visual impairment, intraocular pressure (IOP), and ophthalmic sequelae. Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system. A total of 21 patients were identified. Male-female ratio was 13/8. The mean age of the patients was 8.5±3.4 years. Mean post-treatment follow-up was 8.2±4.3 months. Injury was unilateral in all cases (10 right eye, 11 left eye). Fifteen patients (71.4%) had open globe, and 6 (28.5%) had closed globe injury. Type of injury was rupture in 7 cases, perforation in 5, penetration in 4, and intraocular foreign body in 4. A total of 5 cases were documented to have retinal detachment during the follow-up. Sharp injuries were documented in 11 (64.7%) cases, and blunt in 6 (35.2%). The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. Five patients had choroidal hemorrhage, 3 had commotio retinae, 2 had intravitreal hemorrhage, 1 had subhyaloidal hemorrhage, 1 had macular hole, and 1 had optic nerve avulsion. Lens aspiration was performed in 12 (57.1%) cases, and 2 of them had intraocular lens implantation. In children whose initial vision was able to be taken, 4 had no light perception, 7 had light perception-counting fingers, and 5 had best-corrected visual acuity of 0.05-0.3. At final visit, 61.9% of patients had a VA of 0.05-0.8. Corneal scar or leucoma was observed in 14 (66.6%) cases at last visit. One eye was enucleated due to post-traumatic endophthalmitis that did not respond to treatment. At final visit, IOP <6 mmHg was identified in 2 cases and >21 mmHg in 4. Anterior segment damage is the main cause of visual morbidity in pediatric ocular trauma. Injuries with sharp objects occur twice as often as blunt trauma and reduce vision with residual corneal scarring in about two-thirds of patients. Under-standing the pattern of eye injuries is useful in determining the strategies required to protect children's eye health.

Anterior traumatic optic neuropathy and optic nerve avulsion with one-year follow-up

Anterior traumatic optic neuropathy and optic nerve avulsion with one-year follow-up

Pathomechanism of optic nerve avulsion

Optic nerve avulsion following peri-orbital trauma is an enigmatic clinical entity. Several mechanisms and ideas have been put forward to derive a logical conclusion, however, each factor independently does not appear to explain the mechanism in a logical way, therefore, here we elaborate the probable chain of events responsible for this complication. During isolated blunt trauma to the orbital framework, the globe continues to move anteriorly without any active resistance, in contrast to the globe, the optic nerve with more delicate bony and soft tissue relations, likely to remain relatively static. Thus the junction between the optic nerve and ocular coat suffers the maximum distractive injury due to anteroposterior tractional forces. In addition to this, physiological Bell’s phenomenon may induce torsional tension at this junction leading to further worsening of distractive forces and violent separation of optic nerve from the globe.

Unilateral Traumatic Optic Nerve Avulsion: A Case Report

Optic nerve avulsion is a rare presentation of ocular injury. We present a case of a male mechanic who sustained luxation of the globe and optic nerve avulsion as a result of ocular injury from a car antenna while at work. He became blind in that eye with a final visual acuity of no perception of light. The use of protective goggles at work is recommended.

Analytical study of 100 cases of traumatic optic neuropathy

INTRODUCTION: Traumatic optic neuropathy is a devastating potential complication of closed head injury. The hallmark of an optic neuropathy, traumatic loss of visual function, which can manifest by subnormal visual acuity, visual field loss, or colour vision dysfunction. The presence of an afferent pupillary defect strongly suggests a prechiasmal location for the injury and is necessary to validate the diagnosis of traumatic optic neuropathy. Vision loss associated with traumatic optic neuropathy can be partial or complete and temporary or permanent. Approximately 1.5% to 5% of patients with closed head injuries have damage to visual pathways (4-6 / 100,000 general population / yr). These injuries can be divided into anterior and posterior lesions. Anterior lesions shows ophthalmoscopic abnormalities (eg. Central retinal artery occlusion) and usually associated with a variety of easily recognized injuries to the globe. Anterior lesions may include optic nerve avulsion, traumatic anterior ischemic optic neuropathy, anterior optic nerve sheath hematoma. Posterior lesions are free of ophthalmoscopic findings, but disc edema and disc pallor do occur. Posterior traumatic optic neuropathy is characterised by visual loss that occur in the presence of an afferent pupillary defect but without evidence of injury to the eye or optic nerve. AIM AND OBJECTIVES: To analyse the clinical profile, response to mega dose steroid therapy and visual function outcome in patients with traumatic optic neuropathy presenting to the neuroophthalmology clinic at Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai. MATERIALS AND METHODS: A prospective observational case study on the pattern of traumatic optic neuropathy and analysis of clinical profile, response to treatment and visual function outcome was conducted in the department of neuroophthalmology at RIO-GOH, Chennai. The study was conducted from June 2008 to November 2010. All eligible traumatic optic neuropathy patients according to inclusion criteria, presented to the neuroophthalmology clinic at RIO-GOH during June 2008 to may 2010 were included in the study. DISCUSSION Hippocrates might have been the first to identify the phenomenon of acute and delayed vision loss after injuries placed to and slightly above the brow. While there is little controversy on the macroscopic mechanism of trauma theory, multiple hypothesis have been proposed at microscopic level of damage to the optic nerve including contusion necrosis, nerve fibre tears and nerve infarction secondary to closed space edema, haemorrhage, thrombosis, vasospasm, impingement by bone spicules and shearing of dural vessels in the optic canal. In our study it is evident that traumatic optic neuropathy is devastating cause of permanent visual loss. Concussive force to head especially forehead transmits shock wave to optic canal. Visual loss is usually instantaneous. SUMMARY: Traumatic optic neuropathy is a rare but significant cause of post traumatic visual loss. The responsible blunt trauma to the frontal region may be minor or severe and accompanied by multiple adjacent fractures. Careful documentation of visual acuity, pupillary function, and red desaturation is essential to guide management. CT imaging should be performed to document such structural abnormalities as optic nerve avulsion, optic nerve sheath hematoma, orbital hematoma, or optic canal fracture with fragments. Based on the data from the International Optic Nerve Trauma Study, observation without intervention is a viable option. Patients and their families should be made aware of the information regarding mega dose corticosteroid therapy and participate in an informed decision. In particular, if visual acuity begins to deteriorate, then corticosteroid therapy should be considered. If a structural abnormality is present that may be contributing to optic nerve dysfunction (hematoma or fragment) or if the patient’s visual acuity deteriorates on corticosteroids, optic canal decompression should be offered. Management of this disorder remains very controversial; involvement of other appropriate subspecialists and careful discussions with the patient and family are essential to maximize visual outcome. FUTURE AND CONTROVERSIES: A better understanding of the cellular and biochemical mechanisms involving normal and traumatized axons, glia, and myelin sheaths may eventually leads to better intervention for traumatic optic neuropathy. Although corticosteroids are a type of neuroprotective agents, the recent expansion in basic scientific research regarding other neuroprotective agents may lead to a redirection in future therapy for this condition. CONCLUSION: In our study the clinical profile of 100 eligible patients who presented with loss of vision following trauma during June 2008 – May 2010 were analyzed. RESULTS: Based on exclusion and inclusion criteria 100 cases were taken up for the study.