Optic Nerve Avulsion from Optochiasmal Region Secondary to an Animal Attack: A Case Report.

ABSTRACT: Optic nerve avulsion without bone fracture was observed in four cases in the literature. This case is unique with its cranial effects and complications. A 50-year-old Caucasian female patient attacked by an animal on her left eye was admitted. Traumatic subarachnoid hemorrhage in the suprasellar cistern and epidural hematoma was observed upon brain computed tomography (CT). Enucleation and duraplasty were performed on the patient whose epidural hemorrhage did not increase. Two weeks after being discharged, the patient presented to the emergency room again with numbness on the right side of her face and sensory aphasia. The patient was followed up by medical treatment with left temporoparietal infarction and had completely recovered. Optic nerve avulsion secondary to trauma is a topic that needs to be carefully investigated due to potentially fatal complications. This article was written to share our experience with this rare condition and its case management.

Anatomical Study and Clinical Application of Optic Canal Decompression Via Transethmoid-sphenoid Approach Under Endoscope.

This study aimed to evaluate the safety and accuracy of the endoscopic transethmoid-sphenoid approach for optic canal decompression. Twelve sides of 6 adult cadaveric heads fixed in formalin were selected to simulate optic canal decompression using the endoscopic transethmoid-sphenoid approach. Furthermore, this approach was used for optic canal decompression in 10 patients (11 eyes) with optic nerve canal injury. Related anatomical structures were observed using a 0-degree endoscope, and the anatomical characteristics as well as the surgical data were collected. The maximum effective widths of the cranial opening, orbital opening, and middle segment of the canal that could be drilled open endoscopically were 7.82±2.63, 8.05±2.77, and 6.92±2.01 mm, respectively. The angle between the line linking the center point of the tubercular recess with the midpoint of the cranial opening of the optic canal and the horizontal coordinate was 17.23±1.34 degrees. At the orbital opening of the optic canal, the ophthalmic artery was located directly inferior to the optic nerve in 2 cases (16.7%) and laterally inferior to the optic nerve in 10 cases (83.3%). Six of the operational eyes were effective while the remaining 5 were ineffective. No postoperative complications such as bleeding, infection, or cerebrospinal fluid leakage were observed during the follow-up period (6-12 mo). In conclusion, optic canal decompression positively impacts the prognosis of partial traumatic optic neuropathy. Furthermore, the endoscopic transethmoid-sphenoid approach for optic canal decompression is a minimally invasive procedure that provides direct access and adequate decompression. This technique is easy to master and suitable for clinical applications.

[Efficacy and prognostic factors of endoscopic optic canal decompression in children with traumatic optic neuropathy].

Objective: To explore the efficacy and prognostic factors of endoscopic optic canal decompression in children with traumatic optic neuropathy (TON). Methods: The clinical data of 47 children with TON treated with endoscopic optic nerve decompression in the Department of Neurosurgery of Beijing Tongren Hospital from November 2010 to October 2021 were retrospectively analyzed, and the visual acuity before and after treatment was compared. The clinical factors were taken as independent variables, and visual improvement was taken as dependent variable for multivariate Cox regression analysis to observe the factors that may affect the efficacy. Results: There were 47 patients in this study, including 35 males and 12 females, and the age ranged from 3.0 to 12.0 (7.2±2.3) years. After surgery and hormone treatment, 28 (59.6%) cases obtained visual improvement. Univariate analysis showed that the improvement rate of visual acuity in patients with residual vision after injury was higher than that in patients without vision [85.0% (17/20) vs 40.7% (11/27), P=0.002], while the improvement rate of visual acuity in patients with dislocated optic canal fracture was lower than that in those without fracture [42.1% (8/19) vs 71.4% (20/28), P=0.044]. The improvement rate of visual acuity in patients with operation time interval ≤7 d was higher than that in patients with operation time interval>7 d [80.8% (21/26) vs 33.3% (7/21), P=0.001]. Multivariate Cox regression analysis showed that post-traumatic residual visual acuity (HR=3.805, 95%CI: 1.087-13.318, P=0.037) and operation time interval≤7 d (HR=2.883, 95%CI: 1.084-7.662, P=0.034) were protective factors for post-surgical visual acuity. Conclusions: Endoscopic optic nerve decompression can effectively improve the visual acuity of children with TON. Post-traumatic residual visual acuity and operation time interval ≤7 d are independent protective factors for post-surgical visual acuity.

[Optic nerve decompression-state of the art]. / Optikusdekompressionen ­ Stand der Technik.

Rarely, but often with serious consequences for the patient, the optic nerve is affected during the course of head injuries. Traumatic optic nerve compression is always an emergency situation, which is why time is of the essence for both diagnosis and treatment. Precise knowledge of this accident sequelae but also of the resulting conditions, especially in terms of traumatic optic neuropathy, is indispensable for adequate patient care. The aim of this paper is to provide an overview of this clinical picture, particularly with regard to etiology, diagnosis, and treatment options, and to discuss this in the context of the current literature.

Tunable alginate hydrogels as injectable drug delivery vehicles for optic neuropathy.

Many disease pathologies, particularly in the eye, are induced by oxidative stress. In particular, injury to the optic nerve (ON), or optic neuropathy, is one of the most common causes of vision loss. Traumatic optic neuropathy (TON) occurs when the ON is damaged following blunt or penetrating trauma to either the head or eye. Currently, there is no effective treatment for TON, only management options, namely the systematic delivery of corticosteroids and surgical decompression of the optic nerve. Unfortunately, neither option alleviates the generation of reactive oxygen species (ROS) which are responsible for downstream damage to the ON. Additionally, the systemic delivery of corticosteroids can cause fatal off-target effects in cases with brain involvement. In this study, we developed a tunable injectable hydrogel delivery system for local methylene blue (MB) delivery using an internal method of crosslinking. MB was chosen due to its ROS scavenging ability and neuroprotective properties. Our MB-loaded polymeric scaffold demonstrated prolonged release of MB as well as in situ gel formation. Additionally, following rheological characterization, these alginate hydrogels demonstrated minimal cytotoxicity to human retinal pigment epithelial cells in vitro and exhibited injection feasibility through small-gauge needles. Our chosen MB concentrations displayed a high degree of ROS scavenging following release from the alginate hydrogels, suggesting this approach may be successful in reducing ROS levels following ON injury, or could be applied to other ocular injuries.

Vision improvement in indirect traumatic optic neuropathy treated by endoscopic transnasal optic canal decompression.

BACKGROUND: Indirect Traumatic optic neuropathy (ITON) is a severe disease characterized by a sudden decline of visual function after craniofacial injury. However, the best treatment for ITON is unknown. Endoscopic transnasal optic canal decompression (ETOCD) has gradually been used for ITON treatment worldwide in recent years. OBJECTIVE: To assess the effect of ETOCD on visual acuity in patients with ITON and identify factors that affect prognosis. METHODS: In this study, clinical characteristics of 44 ITON patients who underwent ETOCD in Qilu Hospital of Shandong University were retrospectively analyzed. Factors affecting prognosis were also evaluated. RESULTS: ETOCD treatment improved the vision of 20 (45.5%) patients with no patient suffering from vision deterioration. The mean value of visual acuity (VA) scores improved from 1.57 to 2.39 (P < 0.001). Patients with residual vision had a better VA improvement percent than those without light perception (66.67% versus 34.48%, χ2 = 4.13, P = 0.042). Although shorter duration before ETOCD was associated with better improvement score in ITON patients (r = -0.30, P = 0.044), optic canal fracture (OCF) and optic nerve sheath incision did not affect the prognosis of these patients. Five ITON patients with cerebrospinal fluid rhinorrhea were treated with free nasal mucosal flap during the surgery, and no other severe surgical complication occurred. CONCLUSIONS: ETOCD can effectively and safely improve the vision of ITON patients, patients with residual vision and those treated earlier may benefit more from this surgery.

Traumatic optic neuropathy: a review of current studies.

Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma that directly or indirectly damages the optic nerve and can cause severe vision loss. The incidence of TON has been gradually increasing in recent years. Research on the protection and regeneration of the optic nerve after the onset of TON is still at the level of laboratory studies and which is insufficient to support clinical treatment of TON. And, due to without clear guidelines, there is much ambiguity regarding its diagnosis and management. Clinical interventions for TON include observation only, treatment with corticosteroids alone, or optic canal (OC) decompression (with or without steroids). There is controversy in clinical practice concerning which treatment is the best. A review of available studies shows that the visual acuity of patients with TON can be significantly improved after OC decompression surgery (especially endoscopic transnasal/transseptal optic canal decompression (ETOCD)) with or without the use of corticosteroids. And new findings of laboratory studies such as mitochondrial therapy, lipid change studies, and other studies in favor of TON therapy have also been identified. In this review, we discuss the evolving perspective of surgical treatment and experimental study.

Optic nerve injury in preoperative imaging is associated with visual improvement outcome in endoscopic optic nerve decompression.

OBJECTIVE: To evaluate potential clinical parameters having an impact on visual outcome after endoscopic optic nerve decompression in acute optic neuropathy patients. METHODS: A retrospective chart review of patients with acute optic neuropathy, who underwent endoscopic optic nerve decompression between June 2001 and November 2018 at an academic center was performed. Patients were divided into groups according to visual improvement after surgical treatment (yes/no). Following clinical parameters were compared between groups: perioperative steroid use, evidence of optic nerve affection in preoperative neuroimaging, additional optic nerve sheath incision, surgery delay and preoperative C-reactive protein (CRP) levels. Further subgroups analyses were conducted based on etiology (trauma/tumor). RESULTS: Among 32 included cases, 16 patients (50%) reported visual improvement after endoscopic optic nerve decompression. There was no significant difference in visual improvement between etiology subgroups (trauma: n = 9/20 (45%) vs. tumor: n = 7/12 (58.3%), p = 0.465). Tumor subgroup patients with visual improvement had a significantly higher prevalence of optic nerve affection in preoperative neuroimaging than those without visual improvement (p = 0.018, φ = 0.683). Perioperative steroid administration was negatively associated with visual outcome (p = 0.034, φ = 0.375). Nerve sheath incision, surgery delay and preoperative CRP levels did not have a significant impact on visual outcome (p > 0.05). CONCLUSION: Radiological findings can help as an indicator for surgical treatment since an affected optic nerve in preoperative neuroimaging resulted in better visual outcome after surgery. The use of steroids should be considered more carefully since it did not show any beneficial effect.

Endoscopic trans-ethmosphenoid optic canal decompression is an optimal choice to save vision for indirect traumatic optic neuropathy.

PURPOSE: To evaluate and compare the effectiveness of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) and steroid pulse therapy (SPT) for indirect traumatic optic neuropathy (ITON). DESIGN: Prospective interventional case series. METHODS: Total 140 monocular ITON patients from January 2017 to June 2019 were recruited, including 100 patients received ETOCD (56 patients received ETOCD only and 44 patients received ETOCD combined with SPT before surgery), and 40 patients received SPT only. Their visual acuity (VA) and visual evoked potential (VEP) were analysed before and after treatments. Initial VA, lag time, causes of injuries and age were analysed for evaluating prognosis of treatment. RESULTS: In contrast with patients received SPT only (15/40 = 38%), the effective rate of patients received ETOCD only and patients received ETOCD combined with SPT were both significantly better (46/56 = 82%, p < 0.001 and 30/44 = 68%, p = 0.005). Whether with SPT before ETOCD or not, after ETOCD, patients with VA improvement showed no significant difference. And 59/76 (77.6%) patients showed improvement within 24 hours. Patients who had residual visions achieved higher effective rate than those with no light perception (56/58 = 97% and 20/42 = 48%; p < 0.001) after ETOCD. For patients with long lag time of 21-90 days, 23/32 (72%) patients presented with vision improvement. Moreover, VEP was significantly improved after ETOCD. No severe complications were observed. CONCLUSIONS: Endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) is an effective and safe therapy for ITON, which is more effective than SPT. Even for patients with failure in responding to SPT, the successfully physical decompression is the most effective way to rescue optical nerve from permanent damage.

Nursing Research of Optic Canal Decompression Operation under Nasal Endoscopic Medical Treatment Based on Intelligent Internet of Things for Traumatic Vision Disorders.

Traumatic vision is an important factor that causes people to have a vision. In our country, the vast majority of vision is caused by trauma. To understand the role of optic nerve decompression in the treatment of traumatic visual disturbances based on the pathological states of traumatic visual disturbances and intelligent Internet of tumors medical nasal endoscopy optic nerve decompression. This article collects relevant information by investigating patients, investigating relevant literature, interviewing professionals, etc., constructing a case template and using a comprehensive quantitative and qualitative analysis method to create a damage assessment matrix. The results of the study found that most traumatic vision disorders occur in the young and middle-aged stage, which is more than three times that of other age groups. The permanent blindness rate of patients reaches 8%, which is extremely harmful. Optic canal decompression surgery can play a great role in the treatment of patients. It can greatly reduce the patient's neurological damage. The effect is about 30% higher than that of general treatment methods, and it can also play a certain role in the prognosis of rehabilitation. It can effectively prevent related postoperative complications. This shows that optic canal decompression in the treatment of traumatic vision disorders should attract people's attention and increase research and development efforts and promotion efforts so that optic canal decompression can be used in the diagnosis and treatment of patients with traumatic vision disorders based on smart Internet of things China can play a greater role.

Predictors for Surgeries With the Endoscope-Navigation System for Traumatic Optic Neuropathy and its Clinical Assessment.

BACKGROUND: To assess surgeries with the endoscope-navigation system (ENS) in patients who underwent traumatic optic neuropathy (TON) and find predictors for best corrected visual acuity (BCVA) outcomes. METHODS: The clinical data of 96 consecutive TON patients (96 eyes) who underwent decompression surgery with ENS in the Department of Ophthalmology, Shanghai Ninth People's Hospital, from January 2013 to December 2019 were retrospectively reviewed and analyzed. A binary logistic regression was performed to establish a predictive model for BCVA after treatment as TON outcome. RESULTS: By practicing ENS, 49/96 (51.0%) TON patients got improvement in BCVA, whereas the improvement rate of patients with BCVA of light perception or better was 72.5% (29/40). Hemorrhage within the postethmoid and/or sphenoid sinus, orbital fracture, time interval between trauma and treatment, and BCVA before treatment were predictors for BCVA improvement in TON patients by practicing ENS surgery. The area under raw current curves of the predictive model was 0.826. CONCLUSIONS: Surgeries with the ENS showed positive outcomes for TON patients, especially for those with better BCVA before treatment, shorter time interval between trauma and treatment, without orbital fracture or hemorrhage within the postethmoid and/or sphenoid sinus.

A Meta-Analysis of Traumatic Orbital Apex Syndrome and the Effectiveness of Surgical and Clinical Treatments.

PURPOSE: Traumatic orbital apex syndrome (TOAS) commonly occurs secondary to trauma and irreversible ischemic optic neuropathy occurs as early as 2 hours after injury. Multiple treatment options have been described, however, there is a lack of consensus regarding the optimal treatment of these patients. METHODS: A systematic review of the PubMed Database from 1970 to 2020 was conducted, using the search terms "orbital apex," "syndrome," and "traumatic" with the Boolean operators "AND" or "OR." Papers that did not describe TOAS, describe patient outcomes or treatments, and those without available full English text were excluded. Patients were clustered and compared based on treatment received with the primary outcomes of improvement in vision or ophthalmoplegia. RESULTS: Three hundred forty-seven papers were identified, of which 22 were included, representing 117 patients with TOAS. A total of 75.9% patients underwent decompressive surgery, 82.6% received steroids, and 72.2% received nerve growth factors. Fewer than 20% of patients were treated with antibiotics, diuretics, hormones, or hyperbaric oxygen. Overall, 51.7% of patients experienced improvement in vision and 85.2% in ophthalmoplegia at 6 months. Patients treated with surgical decompression (66.7% versus 16.7%, P < 0.01) or steroids (60.0% versus 0%; P < 0.01) were more likely to have improvement in vision than those without treatment. Nerve growth factors did not improve vision. Ophthalmoplegia did not improve with any treatment. CONCLUSIONS: Outcomes of TOAS tend to be poor, with overall low recovery of vision, though surgical decompression or steroid treatment did suggest improved visual outcomes. Further standardized patient data is needed to elucidate the comparative effectiveness of these interventions.

Outcome of the surgical decompression for traumatic optic neuropathy: a systematic review and meta-analysis.

There exists a persisting controversy regarding the indications for optic nerve surgical decompression (ONSD) in traumatic optic neuropathy (TON). A meta-analysis is warranted to help guiding therapeutic decisions and address gaps in knowledge. The authors conducted a search of PubMed and MEDLINE electronic databases. Primary endpoint was the improvement in the visual function with ONSD in comparison with the conservative management. Secondary endpoint was visual function improvement when surgery was performed within the first 7 days. A random effects model meta-analysis was conducted. Data from each study were used to generate log odds ratio and 95% confidence intervals, to compare post-operative visual improvement. Nine studies met the inclusion criteria for analysis, comprising 766 patients. Visual improvement occurred in 55% (198/360) of patients treated with ONSD, and in 40% (164/406) of those who underwent conservative treatment. Forest plot revealed significant differences in the visual function improvement among these two groups, although further analysis revealed the studies were heterogeneous (log OR, 0.81; CI, 0.07-1.55; I2, 62.8% p = 0.015). Overall, patients who underwent early surgery had better visual outcomes (log OR, 0.94; CI, 0.29-1.60; I2, 0% p = 0.9). ONSD is an effective technique to improve the outcome in the visual function in patients with TON. A lack of randomized controlled trial-and inherent surgical selection and publication bias-limits direct comparison between surgical decompression and conservative management. Suitably designed prospective cohort studies may be useful in identifying patients more likely to receive benefit from ONSD.

Combination analysis on the impact of the initial vision and surgical time for the prognosis of indirect traumatic optic neuropathy after endoscopic transnasal optic canal decompression.

To analyze the impact of the initial vision and surgical time for endoscopic transnasal/transethmosphenoid optic canal decompression (ETOCD) in the treatment of indirect traumatic optic neuropathy (TON). This retrospective case series analysis included 72 patients with indirect TON who underwent ETOCD from August 2017 to May 2019. Visual acuity (VA) was compared before and after surgery to estimate the improvement rate. The overall VA improvement rate of ETOCD was 54.2%. There were 83.3% and 33.3% improvement rate of patients with residual vision and blindness, respectively. VA was improved in 60.9% of patients treated within 3 days, 61.5% treated within 7 days, and 35.0% treated later than 7 days. Of the blindness patients, 50.0%, 37.5%, and 0.0% were treated within 3 days, 3-7 days, and later than 7 days, respectively. Of patients with residual vision, 85.7%, 92.3%, and 70.0% were treated within 3 days, 3-7 days, and later than 7 days, respectively. A statistically significant difference was found between patients with residual vision and those with blindness (P < 0.01), as well as between patients who received ETOCD within 7 days and those who received ETOCD later than 7 days (P = 0.043). The improvement rate of blindness patients managed within 3 days (P = 0.008) and 3-7 days (P = 0.035) was significantly higher than that for patients managed beyond 7 days. Indirect TON patients can directly benefit from ETOCD, and patients with residual vision have better improvement rates. ETOCD should be performed as soon as possible to salvage the patient's VA, especially within the first 7 days. For blindness patients, it is necessary to carry out the surgery within 7 days with increased benefit seen before 3 days.

An evolving perspective of endoscopic transnasal optic canal decompression for traumatic optic neuropathy in clinic.

Traumatic optic neuropathy (TON) is a serious complication of craniofacial trauma, which damages the optic nerve indirectly and leads to dysfunction of visual acuity. The clinical intervention for a patient with TON includes optic canal decompression (with or without steroids), treatment with corticosteroids alone, or observation only. Currently, there is a controversy among clinicians as to which treatment is optimal. An increasing number of retrospective studies have unveiled that patients could experience significant improvement in visual acuity after optic canal decompression surgery, particularly endoscopic transnasal/transethmosphenoid optic canal decompression (ETOCD), either with or without corticosteroids. In this review, we discuss the evolving perspective on surgical treatment, specifically ETOCD, for the management of patients with TON and focus mainly on the therapeutic efficacy, safety, and resulting prognosis in the clinic.

Treatment of Optic Canal Decompression Combined with Umbilical Cord Mesenchymal Stem (Stromal) Cells for Indirect Traumatic Optic Neuropathy: A Phase 1 Clinical Trial.

PURPOSE: This study was aimed to investigate the safety and feasibility of umbilical cord-derived mesenchymal stem cell (MSC) transplantation in patients with traumatic optic neuropathy (TON). METHODS: This is a single-center, prospective, open-labeled phase 1 study that enrolled 20 patients with TON. Patients consecutively underwent either optic canal decompression combined with MSC local implantation treatment (group 1) or only optic canal decompression (group 2). Patients were evaluated on the first day, seventh day, first month, third month, and sixth month postoperatively. Adverse events, such as fever, urticarial lesions, nasal infection, and death, were recorded at each visit. The primary outcome was changes in best-corrected visual acuity. The secondary outcomes were changes in color vision, relative afferent pupillary defect, and flash visual evoked potential. RESULTS: All 20 patients completed the 6-month follow-up. None of them had any systemic or ocular complications. The change in best-corrected visual acuity at follow-up was not significantly different between group 1 and group 2 (p > 0.05); however, group 1 showed better visual outcome than group 2. Both groups showed significant improvements in vision compared with the baseline (p < 0.05); however, there were no statistically significant differences between the groups (p > 0.05). In addition, no adverse events related to local transplantation were observed in the patients. CONCLUSIONS: A single, local MSC transplantation in the optic nerve is safe for patients with TON.

Outcome of Endoscopic Optic Nerve Decompression for Traumatic Optic Neuropathy.

OBJECTIVE: This study aimed to evaluate the outcomes of endoscopic optic nerve decompression (EOND) for adults with traumatic optic neuropathy (TON) and seek factors that might affect surgery outcomes. METHODS: From January 2016 to June 2019, 16 adults diagnosed with TON, who underwent endoscopic trans-ethmosphenoid optic canal decompression, were reviewed. All the patients were treated with steroids before the surgery. The main outcome measure was an improvement in visual acuity (VA) after treatment. RESULTS: Eight (50.0%) patients had residual vision before the surgery, while eight (50.0%) had no light perception. After surgical decompression, partial recovery of VA was achieved in three (18.75%) patients who were operated within 10 days and had residual vision before the surgery. However, no improvement in VA was observed for the remaining patients (81.25%) who were operated more than 10 days after injuries. CONCLUSIONS: EOND is beneficial for TON not responding to steroid therapy and can prevent permanent disability if earlier intervention is done prior to irreversible damage to the nerve. Endoscopic optic nerve surgery can decompress the traumatic and edematous optic nerve with proper exposure of optic canal and orbital apex without any major complications. The operation timing and residual vision are important factors affecting outcomes.

Interventions for Indirect Traumatic Optic Neuropathy: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the literature on the efficacy and safety of medical and surgical interventions for indirect traumatic optic neuropathy (TON), defined as injury to the nerve that occurs distal to the optic nerve head. METHODS: A literature search was conducted on October 22, 2019, and updated on April 8, 2020, in the PubMed database for English language original research that assessed the effect of various interventions for indirect TON. One hundred seventy-two articles were identified; 41 met the inclusion criteria outlined for assessment and were selected for full-text review and abstraction. On full-text review, a total of 32 studies met all of the study criteria and were included in the analysis. RESULTS: No study met criteria for level I evidence. Seven studies (1 level II study and 6 level III studies) explored corticosteroid therapy that did not have uniformly better outcomes than observation. Twenty studies (3 level II studies and 17 level III studies) assessed optic canal decompression and the use of corticosteroids. Although visual improvement was noted after decompression, studies that directly compared surgery with medical therapy did not report uniformly improved outcomes after decompression. Four studies (1 level II study and 3 level III studies) evaluated the use of erythropoietin. Although initial studies demonstrated benefit, a direct comparison of its use with observation and corticosteroids failed to confirm the usefulness of this medication. One study (level II) documented visual improvement with levodopa plus carbidopa. Complication rates were variable with all of these interventions. Pharmacologic interventions generally were associated with few complications, whereas optical canal decompression carried risks of serious side effects, including hemorrhages and cerebrospinal fluid leakage. CONCLUSIONS: Despite reports of visual improvement with corticosteroids, optic canal decompression, and medical therapy for indirect TON, the weight of published evidence does not demonstrate a consistent benefit for any of these interventions. In summary, no consensus exists from studies published to date on a preferred treatment for TON. Treatment strategies should be customized for each individual patient. More definitive treatment trials will be needed to identify optimal treatment strategies for indirect TON.

Traumatic avulsion of the globe with optic nerve transection: an unusual presentation.

Complete globe extrusion, whether traumatic or spontaneous, is a rare clinical entity and if associated with optic nerve avulsion, it has a worse visual outcome, though repositioning of the globe may be attempted. We report a case of road traffic accident, wherein the patient presented with an extrusion of the globe, along with a complete transection of the optic nerve, about 4 cm from the optic nerve head, with only a residual attachment to the orbital rim via the unsevered lateral conjunctival flap, where the enucleation was completed and the conjunctiva was sutured.