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CASE REPORT |
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| Year : 1989 | Volume
: 37
| Issue : 4 | Page : 199 |
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Bilateral traumatic intra orbital optic nerve transection-Case report
Madhumati Misra, Sanathan Rath, Amar Bikram Mohanty
Neuro Ophthalmic section, SCB Medical College, Cuttack 753 007, India
Correspondence Address:
Madhumati Misra
Neuro Ophthalmic section, SCB Medical College, Cuttack 753 007
India
PMID: 2638314
How to cite this article:
Misra M, Rath S, Mohanty AB. Bilateral traumatic intra orbital optic nerve transection-Case report. Indian J Ophthalmol 1989;37:199 |
How to cite this URL:
Misra M, Rath S, Mohanty AB. Bilateral traumatic intra orbital optic nerve transection-Case report. Indian J Ophthalmol [serial online] 1989 [cited 2013 May 25];37:199. Available from: http://www.ijo.in/text.asp?1989/37/4/199/26045 |
| Introduction | |  |
Complete bilateral traumatic section of the optic nerve is rare. [1],[2],[3],[4],[5],[6] We report here the first such with review of available literature upto date.
| Case report | | |
I J, a 40 year old truck driver was involved in a road accident and was hospitalised. His face hit against the glass window in front of him and the sharp aluminium frame (20" x 1") entered up to the anterior cranial fossa after completely damaging the bony orbital roof. The foreign body was retained across the anterior cranial foss and about 6" of the metal was projecting on either side of the temple when he was brought to the hospital. He was in a state of deep unconsciousness and urgent surgical exploration was undertaken. Pre-operative computerised scanning (CT) of the orbits could not be obtained as the patient's head with the projecting metal bars on either side could not enter into the CT scanner machine.
At surgery both orbits were found to be grossly damaged. The optic nerves were transected in the orbit and both the eye balls were dislocated. The retained bar was removed and toileting of the wound was done. The dislocated globes were also removed in the same sitting. Post-operative CT scan showed bilateral frontal lobe contusion and gross orbital laceration. The patient expired on the 4th post-operative day due to meningitis. At autopsy, the cut ends of the optic nerves were clearly seen in the orbit.
| Discussion | | |
Complete avulsion of the optic nerve within the orbit is rare and in most instances it follows missile injury [2],[3],[4]. Bilaterality of this condition has not yet been documented. Computerised tomographic study (CT Scan) of the orbit can readily outline the cut ends of the nerve [1],[5].
Such orbito-facial-cranial penetrating wounds secondary to foreign bodies entering through the face, maxillary sinus orbital area orfrontal sinus should be regarded as potential sources of infection. A hidden CSF leak or meningitis may occur. The pulped brain and bone fragments should be removed and dura should be closed [3],[4],[5]. If this is not done, necrotic/contaminated brain matter will be a source of infections [5]. If the frontal sinus is penetrated the posterior wall of the bone should be removed and dura closed. Orbito-facial wounds rarely cause a traumatic aneurysm, and angiography should be considered before surgery [6].
| References | | |
| 1. | Ganapathy K, Neurology India, 34,218,1986.  |
| 2. | Hughes B, Craniocerebral injury in modern ophthalmology,Vol.,2,Butterworths, London, p.628,1963. . |
| 3. | Turner JWA,Brain 66,140,1943. |
| 4. | Misra M, Rath S,Ind. Jr., Ophthalmol.,33,105,1985. |
| 5. | Becher DP,Miller JD,Young HF Head injury in adults in youmans neurological surgery, Youman Jr. Edn.Vol.4, 1982. |
| 6. | Petty JM Jr., Neu rosurgery,30,741,1 966. |
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