Papillopathie traumatique : à propos d’un cas d’arrachement partiel du nerf optique

Retrospective review of Duke men's basketball eye care: annual screenings and traumatic injuries

OBJECTIVES

1) To assess the utility of performing eye screenings for healthy basketball players. 2) To describe the traumatic injuries sustained by competitive college basketball players.

METHODS

The eye screening examinations of the Duke University Men's Basketball players over six seasons were reviewed retrospectively. Traumatic basketball-related eye injuries amongst Duke University Men's Basketball players over 16 seasons were also reviewed and described.

RESULTS

Forty-four total players underwent screening examinations. Thirteen (29.5%) of athletes had uncorrected or under-corrected refractive errors. One athlete was found to have a severe monocular visual deficit secondary to a traumatic injury in childhood, which was significantly mitigated by a contact lens referral. Eight traumatic ocular injuries in eight different athletes, 8.6% of the total roster players in this interval, required ophthalmologic consultation. Most injuries, 7/8, resulted in no permanent visual impairment. However, two severe episodes of injury required operative intervention, and one episode involving a giant retinal dialysis and traumatic optic nerve head avulsion caused severe, permanent visual loss. Most injuries did not result in significant competition time loss, with a median time loss of 5 days (range 0 to 240 days).

CONCLUSION

Screening eye examinations in healthy athletes are beneficial for the identification and treatment of refractive errors. Traumatic basketball-related eye injuries are common and result in a wide array of injuries. Although most basketball-related eye injuries do no result in permanent visual loss, given the potential for severe injury, many basketball-related eye injuries require expert ophthalmic consultation.

Optic nerve avulsion: Case report

Introduction

Optic nerve avulsion is a traumatic disinsertion of optic nerve fibres from the globe at the level of the lamina cribrosa. It is an uncommon and severe complication of blunt ocular trauma.

Case presentation

We report the case of a 15 years old male presented to the emergency department after being kicked by a horse. Initial ophthalmologic examination of the left eye (LE), exhibited eyelid hematoma, subconjunctival hemorrhage, VA was limited to light perception and there was a left relative afferent pupillary defect. Dilated fundus examination of the LE revealed an extensive vitreous and preretinal hemorrhage overlaying the optic disc and retina edema.The diagnosis of LE optic nerve head avulsion (ONA) was made. Five years after the accident, VA of LE detecting hand motion, fundus examination revealed a superior dragging of the optic disc, fibroglial scarring, retinal vessel narrowing and retinal epithelium hyperplasia.

Clinical discussion

In case of ONA, the avulsion can be missed initially due to vitreous and retinal hemorrhage overlaying the optic nerve, in such cases multimodal imaging can be a useful tool to the diagnosis and to evaluate associated ocular damage. Healing process of the avulsed optic nerve is characterized by the development of fibroglial proliferation. Visual outcome is poor and the final visual acuity range from light perception or no light perception in total ONA.

Conclusion

Optic head nerve avulsion is a rare and severe disease and initial diagnosis is challenging due to associated media opacities. The prognosis is poor and the injury leads to permanent visual impairment.

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Optic nerve avulsion is rare and serious complication of blunt ocular trauma.

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Domestic, work related and sport related accidents are incriminated.

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Diagnosis is challenging because of media opacities associated.

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The prognosis is poor.

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To date, there is no efficient treatment.

[Traumatic optic pit-Optic nerve evulsion caused by indirect ocular trauma]

This article describes the case of a 28-year-old man who suffered an optic nerve evulsion (ONE) after falling from a height of 5 m. On admission visual acuity in the affected left eye was light perception, direct pupillary reaction was unresponsive, and the eye was hypotonic. Because of deep eyelid laceration, hyphemia and severe vitreous hemorrhage a globe rupture was suspected and a surgical exploration with vitrectomy was performed. This resulted in the detection of an ONE. During the following 24 months a painful eyeball due to secondary glaucoma developed and enucleation of the eye became necessary.