Optic nerve avulsion after blunt ocular trauma – Case report
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Department of Vitreoretinal Surgery, Medical University, Lublin, Poland
Corresponding author
Joanna Tomaszewska   

Department of Vitreoretinal Surgery, Medical University, Lublin, Poland
Ann Agric Environ Med. 2016;23(2):382-383
Avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma. The case reported is a 28-year old man presenting to the emergency department due to blunt trauma to his right eye globe with a tree branch. Lid haematoma and subconjunctival haemorrhage were present. Visual acuity soon after the injury was counting fingers (CF) and on admission to the Department of Ophthalmology he had no light perception (NLP). Fundus examination revealed prepapillary haemorrhage, which after few days dispersed into the vitreous cavity. Despite no light perception in the affected eye, the patient was qualified for vitrectomy. During surgery, an optic nerve avulsion with cicatricial gliosis was diagnosed. Six months after vitrectomy, the visual acuity was NLP in the right eye.

The clinical signs, mechanism, treatment and natural history of this poorly known disease are described.

Optic nerve avulsion must be considered in cases of trauma with forced rotation of the eye. Damage occurring at the disc may suggest mechanisms involving anterior luxation of the globe, retropulsion of the nerve, forced globe rotation, or a sudden explosive rise in intraocular pressure blowing the nerve off the sclera into its dural sheath. Damage and break of the nerve fibres are responsible for immediate visual impairments, and involving secondary haematomas and oedemas In spite of required safety precautions in agriculture work, eye injuries are still prevalent. Blunt ocular trauma remains a large part of this group, leading even to irreversible blindness.

Hillman J, et al. Complete avulsion of the optic nerve Brit J Ophthal. 1975; 59: 503.
Anand S, Harvey R, Sandramouli S. Accidental self-inflicted optic nerve head avulsion. Eye (Lond). 2003 Jul; 17(5): 646–7.
Pirouzmand F. Epidemiological trends of traumatic optic nerve injuries in the largest Canadian adult trauma center. J Craniofac Surg. 2012 Mar; 23(2): 516–20.
Balla L, Ianovici N, Costin D. Pathology of the optic nerve injury. Rev Med Chir Soc Med Nat Iasi. 2012 Oct-Dec; 116(4): 1087–90.
Buchwald HJ, Weingärtner WE, Spraul CW, Wagner P, Lang GK. [Contusion of the optic nerve after minor blunt ocular trauma: case report and literature review]. Ophthalmologe. 1999 Aug; 96(8): 529–33.
Mackiewicz J, Machowicz-Matejko E, Sałaga-Pylak M, Piecyk-Sidor M, Zagórski Z. Work-related, penetrating eye injuries in rural environments. Ann Agric Environ Med. 2005; 12(1): 27–9.
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