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Year : 1989  |  Volume : 37  |  Issue : 4  |  Page : 199

Bilateral traumatic intra orbital optic nerve transection-Case report

Neuro Ophthalmic section, SCB Medical College, Cuttack 753 007, India

Correspondence Address:
Madhumati Misra
Neuro Ophthalmic section, SCB Medical College, Cuttack 753 007
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Source of Support: None, Conflict of Interest: None

PMID: 2638314

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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 2023 Dec 10];37:199. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1989/37/4/199/26045

  Introduction Top

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 Top

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 Top

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 Top

Ganapathy K, Neurology India, 34,218,1986.   Back to cited text no. 1
Hughes B, Craniocerebral injury in modern ophthalmology,Vol.,2,Butterworths, London, p.628,1963. .  Back to cited text no. 2
Turner JWA,Brain 66,140,1943.  Back to cited text no. 3
Misra M, Rath S,Ind. Jr., Ophthalmol.,33,105,1985.  Back to cited text no. 4
Becher DP,Miller JD,Young HF Head injury in adults in youmans neurological surgery, Youman Jr. Edn.Vol.4, 1982.  Back to cited text no. 5
Petty JM Jr., Neu rosurgery,30,741,1 966.  Back to cited text no. 6


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