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Photo Essay
March 1998

Avulsion of the Optic Nerve Head After Orbital Trauma

Arch Ophthalmol. 1998;116(3):394. doi:10.1001/archopht.116.3.394

A 23-YEAR-OLD man struck his left eye in a motor vehicle crash. He noted a complete loss of vision in the eye immediately after the accident. Ophthalmic examination within 1 hour of the injury revealed a visual acuity of 20/20 OD and no light perception OS. The right eye was normal. The left eye had mild edema, ecchymosis of the eyelids, and a small laceration of the upper eyelid. The ocular motility showed diminished elevation of the left eye. The left pupil was dilated and nonreactive. Slitlamp examination disclosed a mild subconjunctival hemorrhage without other anterior segment abnormalities. The intraocular pressure was 12 mm Hg. Ophthalmoscopy revealed complete avulsion of the left optic nerve head,1 associated with minimal vitreous hemorrhage (Figure 1). Neither the physical examination findings nor the computed tomographic scan findings indicated any intraocular foreign body or an entry wound; however, the computed tomographic scan showed an orbital blowout fracture. Two hours later, a dispersed vitreous hemorrhage obscured the view of the fundus. Two weeks later, limited elevation of the left eye persisted, and the visual acuity remained no light perception. Long-term outcome is unavailable; the patient failed to return for follow-up examinations.

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