This 6YO boy developed sudden and complete loss of vision in his left eye immediately following blunt trauma. He was riding a bicycle as a pillion passenger when the bike stopped suddenly, throwing his face against the handlebar. Vision was no light perception. Anterior segments were normal.
Fundus photography shows preretinal blood surrounding the nerve, extending through the macula and into the inferior periphery. A pale-yellow cavity is noted where the nerve head should be. A fresh central retinal artery occlusion (CRAO) with a stagnant blood column is noted, along with some scattered inner retinal hemorrhages. There were no other physical or neurologic injuries.
Learning Points:
Traumatic optic nerve head avulsion is a rare and visually devastating traumatic event in which the optic nerve is forcibly separated from the globe at its junction with the sclera, typically resulting in immediate, severe, and irreversible vision loss. The mechanism involves sudden forceful rotation or anterior displacement of the globe following blunt periorbital trauma, including projectiles, falls, or finger-poke injuries, whereby the globe moves anteriorly or rotationally while the optic nerve remains relatively fixed, causing violent separation. Fundoscopic examination may reveal a partial or complete tear of the optic nerve head from the sclera (Foster et al, Arch Ophthalmol 1997;115:623-630). Avulsion can be partial or complete, and may be associated with a CRAO, as was noted in our patient.
