A 19-YEAR-OLD man was admitted to the emergency department after a motor
vehicle crash. His visual acuity was hand motions OD and 20/20 OS, with moderate
periorbital edema and ecchymosis in his right eye. Slitlamp examination disclosed
only a mild subconjunctival hemorrhage. The ocular motility was normal, and
intraocular pressure was 16 mm Hg OU. Pupillary examination showed a 3+ relative
afferent defect in his right eye. Dilated funduscopic examination revealed
normal optic nerve with a cup-disc ratio of 0.4 OU. A computed tomographic
scan of the head and orbits detected a fracture through the right optic canal.
The patient was treated with steroids, and visual acuity improved to 20/400
OD. Retinal nerve fiber layer (RNFL) measurements using scanning laser polarimetry
(SLP) (Gdx; Retinal Diagnostic Technologies Inc, San Diego, Calif) were taken
at 15 days (Figure 1), 30 days (Figure 2), 45 days (Figure 3), and 90 days (Figure 4) after injury. There was a progressive loss of nerve fibers as
shown by the double-hump curve, deviation from normal values, and GDx parameters.
This was consistent with optic nerve atrophy revealed by ophthalmoscopy 45
days after injury. During the 90 days of follow-up there was no change of
the cup-disc ratio.
Medeiros FA, Susanna R. Retinal Nerve Fiber Layer Loss After Traumatic Optic Neuropathy Detected by Scanning Laser Polarimetry. Arch Ophthalmol. 2001;119(6):920–921. doi:10.1001/archopht.119.6.920
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