Traumatic ischaemic optic neuropathy.

Abstract

Persistent profound visual loss following contusion of the globe or ocular adnexae has been well documented, the visual loss being attributed to haemorrhage into, or contusion of, the optic nerve, or to interference with the blood supply of the eye. The patient described below presented after a contusion of the eye and orbit, with the clinical picture of ischaemic optic neuropathy presumably resulting from injury to the posterior ciliary arteries. Case reportOnJune 30, 197I, a housewife aged 47 years was kicked around the left orbit by a young man wearing leather shoes; 3 days later, as the eyelid haematoma abated, she was able to open her left eye and noticed that she could not distinguish between light and darkness. She immediately attended the emergency eye clinic where it was confirmed that she had no perception of light in this eye. ExaminationThere was bruising of the eyelids with a total bulbar subconjunctival haematoma. There was some proptosis, and depression and elevation in abduction of the globe were deficient. The pupil was dilated, not reacting to light, but reacting briskly consensually. Red blood cells and flare were noted in the anterior chamber. Fundus examination revealed oedema around the disc extending about one disc diameter from its margin. The disc itself was pale with circumferential blurring of the margin. Apart from this, the posterior pole did not show oedema, and there was no cherryred spot at the macula. The retinal vessels appeared normal and there was no cilio-retinal artery. No haemorrhages were seen either on the disc or in the rest of the fundus. X-ray of the facial bones, including tomograms, revealed no fracture at this time, but the left antrum was opaque, probably because of local haemorrhage.The patient was observed in hospital, no specific treatment being given, and 4 days later the left disc was still swollen and pale, the peridisc oedema was regressing, and the eye movements were full. Intraocular tension was 14 mm. Hg in the right eye and 12 mm. Hg in the left. Stereoscopic colour photographs ofeach disc confirmed the swelling and blurring of the optic disc and its margin.Fluorescein angiography showed increase of fluorescence over the whole area of the affected disc as compared to the normal right disc. The left disc also showed leakage of dye from 2 to at least 40 minutes after thedye transit. CourseAfter 4 weeks there was still no perception of light in the left eye, which gave amaurotic pupil responses, and in which optic atrophy was developing. Eye movements were full, but there was still

Optic Neuropathy with Delayed Onset After Trauma: Case Report and Review of the Literature

“…Mechanistically, the first two are the most logical explanations for disc swelling in anterior TON. In our case and that published by Wyllie the pallid disc swelling suggests an ischemic etiology 5 .…”

“…In a case similar to ours, a woman experienced delayed vision to no light perception due to TON starting 3 days after blunt orbital injury. She had pallid swelling of optic nerve and delayed filling of the optic disc on fluorescein angiography, suggesting an ischemic mechanism 5 . In our case, delayed TON presenting upon awakening with anterior pallid disc swelling also suggests an ischemic etiology, perhaps due to compression of the posterior ciliary artery by the swollen medial rectus muscle.…”

Lesões traumáticas do nervo óptico

“…Wyllie et al 30 afirmam que a lesão da via visual decorrente de trauma frontal ocorre por isquemia devida à obstrução das artérias ciliares posteriores.…”

Lesões traumáticas de nervos cranianos

“…Ocorre por desenvolvimento de edema ou isquemia no interior do canal óptico ou compressão por hematoma subperiostal. 2,25,26 Mais raramente ocorre por de senvolvimento de mucoceles ou aneurismas traumáticos.…”