Título / Title

TRAUMATIC COMPLETE OPTIC NERVE HEAD AVULSION IN A PEDIATRIC PATIENT: A CASE REPORT

Introdução / Purpose

To report a clinical case of a 5-year-old patient presenting with a optic nerve head (ONH) avulsion subsequently to blunt trauma.

Material e Método / Methods

A case report.

Resultados / Results

A 5-year-old male with no past medical history, presented at the eye emergency department six days after a bicycle accident. He fell off his bike, and the handlebar went into his eye. The initial ophthalmologic examination exhibited a best corrected visual acuity of no light perception OD and 0.00 (LogMAR) left eye. The boy had proptosis, eyelid hematoma, superior temporal hyposphagma, a 4 millimeters hyphema, and an amaurotic pupil in the OD. Fundoscopy examination revealed preretinal diffuse posterior pole hemorrhage, extensive peripapillary pallor followed with the avulsion of the ONH, and the retinal vessels failing to reach it. A computerized tomography scan demonstrated no orbital fractures. However, no optic nerve abnormalities were visible. Magnetic resonance imaging of the orbits revealed increased enhancement in the intraocular portion of the right optic nerve, which had imprecise delineation and peripapillary enhancement. In the three-month follow-up, an extensive fibroglial scarring was visible on fundoscopy. The multimodal evaluation ultrasonographic exam showed a hyperechogenic area in the ONH topography and the nerve distant from the posterior globe wall. Optical coherence tomography (OCT) highlighted the architecture distortion with fibrosis on the ONH location.

Discussão e Conclusões / Conclusion

Optic nerve avulsion is a rare and irreversible consequente of blunt ocular trauma. It usually occurs following rapid rotational forces applied to the globe, leading to a disconnection of the optic nerve from the eye, and the lamina cribrosa from the scleral edge. Fibroglial proliferation defines the avulsed nerve healing process. As there is no treatment to reestablish the visual acuity, the follow-up aims to monitor possible complications such as phthisis bulbi and secondary neovascularization or rubeotic glaucoma. Both can lead to a painful eye.

Palavras Chave

Optic nerve avulsion, Blunt ocular trauma, Case report

Area

CLINICAL RETINA