Search

Although underestimated, visual involvement is among the most frequent neurological complications of head trauma. There is no consensus in the management of these patients and visual recovery is uncertain. The goal of our study is to describe the clinical presentation and the clinical course of traumatic optic neuropathy in patients with head or maxillo-facial trauma. The clinical records of 8 patients, treated from November 2007 to March 2012, were reviewed in the department of ophthalmology (visual testing) of the university regional medical center in Lille. The most frequent cause of injury was traffic accidents. Unilateral optic neuropathy was observed in 6 cases, and bilateral in two cases, for a total of 10 eyes. Eight presented a significant visual loss<6/12. Improvement of visual acuity was achieved in 5 cases to 9/10 distance acuity without any medical or surgical treatment. One patient required surgical decompression, without improvement of visual acuity, and with persistent oculomotor disturbance and unreactive mydriasis. Traumatic optic neuropathy can cause profound visual acuity loss, especially if it is already significantly decreased on presentation., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Introduction: Partial avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma., Observation: We report the case of a 28-year-old man presenting to the emergency department for blunt trauma to his right eye with a basketball. Visual acuity was decreased to hand motion, and fundus examination showed a prepapillary hemorrhage. After five days, the preretinal hematoma spontaneously dispersed into the vitreous cavity. Because of the persistence of an intravitreal hemorrhage and the lack of visual recovery, a vitrectomy was performed 2 months later, leading to the diagnosis of a partial optic nerve avulsion with cicatricial gliosis on fundus exam and angiography. Six months after vitrectomy, the visual acuity was 4/10 P4 in the right eye and the visual field showed an absolute infero-nasal scotoma corresponding to the temporal injury. Seven months later, the visual acuity had decreased progressively, secondary to the development of a macular epiretinal membrane. A membrane peel was performed with a visual acuity recovery to 3/10 P4 after a 3-year follow-up., Discussion: Through a complete literature review, we describe the clinical signs, the mechanism, the treatment and the natural history of this poorly known disease., Conclusion: Optic nerve avulsion must be considered in cases of trauma with forced rotation of the eye. Individualized management and monitoring of complications are essential to the preservation of residual visual acuity, especially in case of partial avulsion., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Evulsion of the optic nerve is a rare but serious injury. It occurs generally after an ocular contusion and may cause blindness., Case: We report the case of a 53-year-old woman who presented with a blunt ocular trauma after having been punched by her husband. Initial examination of the left eye was impossible due to a major palpebral oedema. A CT scan of the orbit revealed a thickened optic nerve. No improvement was noted., Discussion: Optic nerve avulsion is often caused by sudden and forceful rotation of the eye with tearing of the optic nerve as its globe entry level. The diagnosis can be confirmed by examination of the ocular fundus or by medical imaging such as CT scan of the orbital cavity as in our case report. The prognosis is usually poor.