Optic nerve avulsion from a golfing injury

doi:10.1016/S0002-9394(99)00220-2

American Journal of Ophthalmology

Volume 128, Issue 5, November 1999, Pages 657-658

https://doi.org/10.1016/S0002-9394(99)00220-2 Get rights and content

Abstract

PURPOSE:

To describe a patient with optic nerve avulsion after being struck in the eye with a golf club.

METHODS:

A 10-year-old male was hit in the left eye by a golf club. The patient underwent full ophthalmoscopic evaluation and neuroimaging.

RESULTS:

The patient had no light perception in the left eye when first seen. Avulsion of the optic nerve with vitreous hemorrhage was apparent on examination. Computed tomographic imaging of the brain and orbits revealed no abnormalities.

CONCLUSIONS:

Optic nerve avulsion from golf-related injury is more likely to occur when the impact site is between the globe and the orbital rim. Rupture of the globe is more likely to occur with direct impact to it.

References (5)

M.A. Burnstine et al.
Golf-related ocular injuries
Am J Ophthalmol
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United States Eye Injury Registry Annual Report. Birmingham, Alabama,...

There are more references available in the full text version of this article.

Cited by (23)

Collision of the glass shards with the eye: A computational fluid-structure interaction model
2018, Journal of Chemical Neuroanatomy
Citation Excerpt :
In this study, the stresses in the optic nerve as a result of glass shards’ collision with the eye were computed. In addition, different blunt objects have been assessed via a computational FSI model with the optic nerve avulsion, including snooker cues, golf clubs, and paintballs (Roth and Warman, 1999; Foster et al., 1997). In the defined range of the simulation in the concurrent study, the optic nerve has not been seriously damaged and, as a result, a comparatively low strain (Table 3) and low stress (Fig. 3) was observed in that.
The main stream of blunt trauma injuries has been reported to be related to the automobile crashes, sporting activities, and military operations. Glass shards, which can be induced due to car accident, earthquake, gunshot, etc., might collide with the eye and trigger substantial scarring and, consequently, permanently affect the vision. The complications as a result of the collision with the eye and its following injuries on each component of the eye are difficult to be diagnosed. The objective of this study was to employ a Three-Dimensional (3D) computational Fluid-Structure Interaction (FSI) model of the human eye to assess the results of the glass shards collision with the eye. To do this, a rigid steel-based object hit a Smoothed-Particle Hydrodynamics (SPH) glass wall at the velocities of 100, 150, and 200 m/s and, subsequently, the resultant glass shards moved toward the eye. The amount of injury, then, quantified in terms of the stresses and strains. The results revealed the highest amount of stress in the cornea while the lowest one was observed in the vitreous body. It was also found that increasing the speed of the glass shards amplifies the amount of the stress in the components which are located in the central anterior zone of the eye, such as the cornea, aqueous body, and iris. However, regarding those components located in the peripheral/posterior side of the eye, especially the optic nerve, by increasing the amount of velocity a reduction in the stresses was observed and the optic nerve is hardly damaged. These findings have associations not only for understanding the amount of stresses/strains in the eye components at three different velocities, but also for providing preliminary information for the ophthalmologists to have a better diagnosis after glass shards (small objects impact) injuries to the eye.
Optic nerve trauma: Case report of partial optic nerve avulsion
2013, Journal Francais d'Ophtalmologie
L’avulsion partielle de la tête du nerf optique est une complication sévère et rare des contusions oculaires.
Nous rapportons le cas d’un homme de 28 ans se présentant aux urgences pour contusion de l’œil droit par ballon de basket. L’examen initial retrouvait une baisse d’acuité visuelle à « voit bouger la main ». Le fond d’œil montrait une hémorragie prépapillaire ; au cinquième jour, l’hématome prérétinien se déversait spontanément dans la cavité vitréenne. Deux mois plus tard, devant la persistance de l’hémorragie intravitréenne et l’absence de récupération visuelle, une vitrectomie était réalisée : l’aspect du fond d’œil et l’angiographie confirmaient le diagnostic d’arrachement partiel du nerf optique avec gliose cicatricielle. Six mois après la vitrectomie, l’acuité visuelle était 4/10 P4 et le champ visuel de Goldman retrouvait un déficit absolu du quadrant inféronasal. Sept mois plus tard, on observait une baisse progressive de l’acuité visuelle liée à la constitution d’une membrane épirétinienne maculaire. Un pelage de cette membrane était réalisé permettant une récupération de l’acuité visuelle à 3/10 P4 avec un recul de trois ans.
Nous discuterons, à travers une revue complète de la littérature, la présentation clinique, le mécanisme, le traitement et l’évolution de cette pathologie mal connue.
L’avulsion du nerf optique est une pathologie à laquelle il faut savoir penser devant un traumatisme entraînant une rotation forcée du globe oculaire. Une prise en charge adaptée et une surveillance des complications sont nécessaires à la préservation de l’acuité visuelle résiduelle, en particulier en cas d’avulsion partielle.
Partial avulsion of the optic nerve head is a rare and severe complication of ocular blunt trauma.
We report the case of a 28-year-old man presenting to the emergency department for blunt trauma to his right eye with a basketball. Visual acuity was decreased to hand motion, and fundus examination showed a prepapillary hemorrhage. After five days, the preretinal hematoma spontaneously dispersed into the vitreous cavity. Because of the persistence of an intravitreal hemorrhage and the lack of visual recovery, a vitrectomy was performed 2 months later, leading to the diagnosis of a partial optic nerve avulsion with cicatricial gliosis on fundus exam and angiography. Six months after vitrectomy, the visual acuity was 4/10 P4 in the right eye and the visual field showed an absolute infero-nasal scotoma corresponding to the temporal injury. Seven months later, the visual acuity had decreased progressively, secondary to the development of a macular epiretinal membrane. A membrane peel was performed with a visual acuity recovery to 3/10 P4 after a 3-year follow-up.
Through a complete literature review, we describe the clinical signs, the mechanism, the treatment and the natural history of this poorly known disease.
Optic nerve avulsion must be considered in cases of trauma with forced rotation of the eye. Individualized management and monitoring of complications are essential to the preservation of residual visual acuity, especially in case of partial avulsion.
Traumatic optic nerve avulsion: A case report
2012, Journal Francais d'Ophtalmologie
Citation Excerpt :
Ultra sound tomography can inconstantly show an hypoechogenous dimple behind the optic nerve head or a hole of the globe [2,5,6]. CT scans can demonstrate complete or partial optic nerve avulsion with a linear hyperluency with a retrodisplaced lamina cribosa [7,8]. Furthermore, CT scans can provide the indication of surgical decompression in case of a lesion of the optic nerve in the optical canal [9].
Case report of a traumatic optic nerve avulsion.
We report the case of a traumatic right optic nerve avulsion in an 11-year-old boy as a result of a contusion with a surfboard. On initial examination, the patient exhibited bilateral mydriasis with a right afferent pupillary defect. Visual acuity was no light perception. A moderate microhyphema was noted along with intraocular pressure of 12 mmHg and no open globe. Fundus examination revealed retinal ischemia with white retinal edema, attenuated arteries and segmentally occluded vasculature. In place of the optic nerve, there was a hole with associated vitreous hemorrhage. Non-contrast CT and MRI demonstrated vitreous prolapse into the optic nerve sheath, which still appeared securely attached to the globe. Spectral domain OCT and visual evoked potentials confirmed disruption of the ganglion cell layer.
While obvious in the presence of clear media, an avulsion may remain undetected in the case of associated vitreous hemorrhage. Orbital imaging may clarify the diagnosis.
Although rare, optic nerve avulsions exhibit the same risk profile as open globe injuries and arterial occlusions.
Description d’une avulsion traumatique du nerf optique.
Nous rapportons le cas d’une avulsion traumatique du nerf optique droit par contusion chez un enfant de 11 ans par une planche de surf. À l’examen initial, il existe une mydriase bilatérale, avec un déficit afférent pupillaire droit. L’acuité visuelle est réduite perception lumineuse négative. Cliniquement on note un Tyndall hématique modéré, une tension a 12 mmHg et pas de plaie de globe. Au fond d’œil la rétine est ischémique avec un œdème rétinien blanc, des artères grêles et une circulation interrompue sur certains segments. En lieu et place du nerf optique il y a un trou avec une hémorragie intravitréenne en regard. Un TDM non injecté et une IRM sont réalisés et montrent une issue de vitré dans la gaine du nerf optique qui semble solidaire du globe. L’OCT spectral Domain ainsi que les potentiels évoqués visuels confirment l’interruption des fibres ganglionnaires.
De diagnostic évident lorsque les milieux sont clairs, l’avulsion peut être méconnue en cas d’hémorragie associée. L’imagerie orbitaire peut montrer des images évocatrices.
De survenue rare, les avulsions du nerf optique exposent au même risques qu’une plaie du globe ou une occlusion artérielle.
Optic nerve head avulsion: A case report
2007, Journal Francais d'Ophtalmologie
L’avulsion du nerf optique est une affection rare. Elle se définit comme une rupture des fibres ganglionnaires au niveau de la lame criblée puis d’une rétraction de ces fibres dans la gaine durale intacte du nerf optique. Nous rapportons un cas d’avulsion du nerf optique faisant suite à une contusion oculaire chez un enfant âgé de 5 ans. Le mécanisme lésionnel probable est l’association d’une rotation forcée soudaine du globe, d’une possible exophtalmie aiguë ainsi que d’une augmentation brutale de la pression intra-oculaire. La présence d’hémorragies intra-oculaires n’empêchait pas, dans notre cas, l’examen de la région papillaire qui montrait un cratère. L’acuité visuelle initiale était « absence de perception lumineuse ». Après avoir éliminé une lésion du cadre orbitaire par tomodensitométrie, un traitement antibiotique général ainsi qu’un traitement par collyres (antibiotique/corticoïde et atropine) furent débutés. Aucune récupération visuelle ne survint.
Optic nerve head avulsion is a rare condition. It consists in a rupture of the nerve fibers at the level of the lamina cribrosa followed by a retraction of these fibers into the intact optic sheath. We report a case of optic nerve head avulsion following globe contusion. The association of a sudden forced globe rotation, a possible acute proptosis, and a sudden rise in intraocular pressure likely caused the avulsion. The presence of intraocular hemorrhages did not prevent examination of the optic nerve head region, which showed a crater. Initial visual acuity was no light perception. An orbit bone fracture was ruled out after CT examination. The patient was treated with general antibiotics and eyedrops (antibiotic/corticosteroid and atropine). No visual recovery was observed.
Imaging in eye injury
2023, Ocular Trauma in Armed Conflicts
Isolated traumatic optic nerve avulsion in a boy who suffered a horse kick
2020, Saudi Journal of Ophthalmology

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Brief ReportsOptic nerve avulsion from a golfing injury

Abstract

Am J Ophthalmol

Brief Reports
Optic nerve avulsion from a golfing injury