Focal retinal ischemia revealed by multi-modal imaging after traumatic partial optic nerve avulsion

Retin Cases Brief Rep. 2020 Dec 21;Publish Ahead of Print. doi: 10.1097/ICB.0000000000001114. Online ahead of print.

Abstract

Purpose: Traumatic optic neuropathy can have varying presentations. Blunt focal trauma can lead to optic nerve avulsion with underlying retinal findings. We report a case of partial optic nerve avulsion after finger poke injury leading to focal retinal ischemia.

Methods: Visual acuity, fundus photography with fluorescein angiography (FA), and spectral domain optical coherence tomography (SD-OCT) were performed to document the findings in a 16-year-old male who presented after a finger poke injury to the left orbit during a water polo match.

Results: On initial presentation, exam revealed decreased visual acuity with a fixed left pupil and afferent pupillary defect by reverse. On slit lamp exam of the left eye a hyphema was present. Dilated fundus exam revealed layering vitreous hemorrhage over the posterior pole and an avulsed vitreous base. On follow-up, a gap temporal to the optic nerve head consistent with a partial optic nerve avulsion was noted once the vitreous hemorrhage cleared. Multimodal imaging revealed retinal ischemia temporal to the disc on FA with corresponding changes in the inner retinal layers and retinal nerve fiber layer using SD-OCT.

Conclusion: Clinicians should have a high suspicion for optic nerve avulsion if a patient presents with new vitreous hemorrhage and APD after a finger-poke injury. Optic nerve avulsion injury can cause retinal ischemia, likely due to interruption of retinal blood flow as a result of nerve shearing injury. Multi-modal imaging can reveal focal retinal injury and aid in proper diagnosis and follow-up.