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May 1997

Optic Nerve Avulsion

Author Affiliations

From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston. Dr March is now with the Division of Ophthalmology at Charles R. Drew University, Los Angeles, Calif, and Dr Lucarelli is now with the Department of Ophthalmology and Visual Sciences at the University of Wisconsin, Madison.

Arch Ophthalmol. 1997;115(5):623-630. doi:10.1001/archopht.1997.01100150625008

Objective:  To characterize the presentation, role of diagnostic imaging, and course in patients with optic nerve avulsion.

Methods:  A retrospective review of medical records of all 6 patients with optic nerve avulsion who were seen at the Massachusetts Eye and Ear Infirmary, Boston, from January 1, 1991, to July 31, 1995.

Results:  The initial visual acuity ranged from 20/100 to no light perception. All 6 patients underwent neuroimaging, including computed tomography, magnetic resonance imaging, or both. B-scan ultrasonography was performed on 4 patients, and the condition of 1 patient was evaluated with color Doppler ultrasonography to assess the optic nerve vasculature. In 1 patient, a computed tomographic scan was suggestive of an optic nerve avulsion. Neuroimaging in the other 5 patients, including 2 patients who underwent magnetic resonance imaging, failed to demonstrate an avulsion. During a follow-up period of up to 25 months, 4 patients showed no improvement in visual acuity, 1 patient improved from no light perception to bare light perception, and 1 patient improved from 20/100 to 20/25.

Conclusions:  These data suggest that final visual outcome was dependent on initial postinjury visual acuity. Neuroimaging, B-scans, and Doppler ultrasonography were usually not helpful in establishing the presence of optic nerve avulsion, although they may be useful in evaluating comorbid conditions.