Traumatic optic nerve head avulsion: Multimodal imaging.

A 6-year-old boy presented with sudden vision loss after close globe injury with iron rod. Best-corrected visual acuity (BCVA) was Perception of light (PL). Fundus examination showed an area of the optic nerve head (ONH) excavation and filled with hemorrhage with blood emanating into the vitreous [Fig. 1a]. The patient underwent MRI orbit which confirms the diagnosis of ONH avulsion. The patient received intravenous steroids, but partial avulsion converted into full [Fig. 1b] with BCVA no PL. Optical coherence tomography showed avulsion at ONH section [Fig. 1c]. An area of hypolucency on ultrasound was seen at ONH section [Fig. 1d].

Figure 1

(a) Multicolor photo showing partial optic nerve head avulsion with hemorrhage around disc and emanating into vitreous; (b) complete avulsion after three days of presentation; (c) avulsion at optic nerve head section on optical coherence tomography (yellow arrow); (d) an area of hypolucency on B scan at optic nerve head section (white arrow)

Avulsion of the ONH is a rare complication of ocular trauma. The damage suggests mechanisms involving explosive rise in intraocular pressure blowing nerve off the sclera into its dural sheath which is responsible for visual impairments.[12]

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