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Photo Essay
June 2001

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

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.

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