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LETTER TO THE EDITOR
Year : 2019  |  Volume : 7  |  Issue : 3  |  Page : 128-129

A typical case of optic nerve head avulsion


1 Centre for Retinal Diseases, The Eye Centre, Ahmedabad, Gujarat, India
2 Department of Retina, Sheth C. H. Nagri Eye Hospital, Ahmedabad, Gujarat, India

Date of Web Publication11-Dec-2019

Correspondence Address:
Shachi Rohan Desai
The Eye Centre, 204 Sigma II Complex, Above SBI Bank, Opp. Himalaya Mall, Bodakdev, Ahmedabad - 380 052, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_63_18

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How to cite this article:
Desai SR, Desai T. A typical case of optic nerve head avulsion. J Clin Ophthalmol Res 2019;7:128-9

How to cite this URL:
Desai SR, Desai T. A typical case of optic nerve head avulsion. J Clin Ophthalmol Res [serial online] 2019 [cited 2020 Jan 28];7:128-9. Available from: http://www.jcor.in/text.asp?2019/7/3/128/272712



Sir,

Optic nerve avulsion is a very rare devastating condition following blunt trauma. It is defined as traumatic disinsertion of optic nerve fibers from the globe at the level of lamina cribrosa.[1] Trauma during road traffic accidents and following falls have been most common causes for optic nerve avulsion but there have been reports in the literature where trauma during various sports like basket ball, polo, skate and even self inflicted thumb injury during practice session of Thai kick boxing lead to avulsion.[2] Object striking the globe at an angle leading to extreme rotation and forward displacement of globe is the mechanism behind optic nerve avulsion. Loss of myelin and absence of supportive tissue at lamina cribrosa makes it more susceptible location for disinsertion.[2],[3]

In most of the cases, optic nerve details are obscured by concomitant vitreous hemorrhage. Ultrasonography (USG) is a handy, easily available and affordable modality to confirm the diagnosis in such cases. Hypolucency at the junction of optic nerve and globe followed by hyperlucency posterior to it due to displaced lamina cribrosa are the signs on USG suggestive of disinsertion of optic nerve.[4],[5]

In this case, clinical presentation and fundus findings was clearly suggestive of optic nerve avulsion eliminating further role of any imaging modality for confirmation of ophthalmic diagnosis. A 35-year-old male presented to us with a complaint of loss of vision in the right eye for 3 days. He had a history of trauma to the right eye with a metal rod while traveling in a rickshaw during road traffic accident before 3 days. The patient had consulted local doctors, and he was on tablet prednisolone 50 mg once a day, tablet Vitamin C 500 mg twice a day, and moxifloxacin with prednisolone eye drops four times a day. Visual acuity in the right eye on presentation was no perception of light and in the left eye was 6/6. On distant examination, there was no associated trauma to the head or face. Anterior-segment examination of the right eye revealed a 2 mm × 2 mm-patch of subconjunctival hemorrhage temporally, a clear cornea, a clear lens in position, and normal extraocular movements. Swinging flashlight test revealed relative afferent pupillary defect grade 4 in the right eye and normal pupillary reaction in the left eye. On fundus examination, media was hazy due to minimal vitreous hemorrhage. There was a large retinal tear surrounding the probable position of the optic nerve head with edematous ischemic retina [Figure 1], [Figure 2], [Figure 3]. The excavated area with hemorrhage at the optic nerve head was suggestive of optic nerve head avulsion [Figure 1] and [Figure 3]. The anterior and posterior segments of the left eye were normal on examination.
Figure 1: Large retinal tear with flap

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Figure 2: Nasal periphery of the retina

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Figure 3: Torn-out edematous retina with obscured optic nerve head and macular details

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Salzmann M. Evulsion of optic nerve. Augenheilkunde 1903;9:489-505.  Back to cited text no. 1
    
2.
Anand S, Harvey R, Sandramouli S. Accidental self-inflicted optic nerve head avulsion. Eye (Lond) 2003;17:646-7.  Back to cited text no. 2
    
3.
Roberts SP, Schaumberg DA, Thompson P. Traumatic avulsion of the optic nerve. Optom Vis Sci 1992;69:721-7.  Back to cited text no. 3
    
4.
Foster BS, March GA, Lucarelli MJ, Samiy N, Lessell S. Optic nerve avulsion. Arch Ophthalmol 1997;115:623-30.  Back to cited text no. 4
    
5.
Sawhney R, Kochhar S, Gupta R, Jain R, Sood S. Traumatic optic nerve avulsion: Role of ultrasonography. Eye (Lond) 2003;17:667-70.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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