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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 431-432

Multimodal imaging in partial optic nerve head avulsion


Vitreoretina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India

Date of Submission02-Oct-2020
Date of Acceptance05-Jan-2021
Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Manavi D Sindal
Vitreoretina Services, Aravind Eye Hospital, Thavalakuppam, Cuddalore Main Road, Pondicherry - 605 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3132_20

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  Abstract 


Keywords: Multimodal imaging, ONH avulsion, optical coherence tomography, trauma, ultrasonography


How to cite this article:
Sindal MD, Ratna B, Kota AR. Multimodal imaging in partial optic nerve head avulsion. Indian J Ophthalmol Case Rep 2021;1:431-2

How to cite this URL:
Sindal MD, Ratna B, Kota AR. Multimodal imaging in partial optic nerve head avulsion. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:431-2. Available from: https://www.ijoreports.in/text.asp?2021/1/3/431/320107



A 15-year-old male presented with sudden loss of vision following blunt trauma to his right eye. Visual acuity was no perception of light in right eye and 6/6 in left eye. Anterior segment examination showed conjunctival laceration and afferent pupillary defect in right eye. Fundus examination showed whitening of retina, vitreous hemorrhage with pigments clumps around an excavated optic disc [Figure 1]. Left eye examination was within normal limits. Ultrasonography showed widening of optic nerve head shadow suggestive of Optic Nerve Head Avulsion (ONHA) [Figure 2]. Spectral-domain optical coherence tomography (OCT) revealed loss of continuity of optic nerve head surface with peripapillary retina [Figure 3]. Patient was explained about nil visual prognosis and rehabilitation.
Figure 1: Color fundus photograph of right eye showing minimal vitreous hemorrhage, whitening of adjacent peripapillary retina, and crescentic margin of excavated optic nerve head (blue arrow)

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Figure 2: Ultrasonography of right eye. (a) Widening of the optic nerve shadow seen (yellow arrows) (b) Linear defect in optic nerve head shadow seen extending to a posterior echo lucent area (red arrow) with retraction of optic nerve (asterisk)

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Figure 3: Spectral domain optical coherence tomography of optic nerve head (a) Superior part of optic nerve head showing “V” shaped avulsion (a) Scan from inferior part of optic nerve head shows complete discontinuity of optic nerve from retina. Back shadowing due to overlying vitreous hemorrhage is seen nasally. Hyperreflective peripapillary retinal layers are seen

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  Discussion Top


The diagnosis of ONHA was evident on fundus exam in our case as the vitreous hemorrhage was minimal. The disc is seen to be replaced partially or totally by a defect, surrounded with variable extent of retinal and vitreous hemorrhage. Due to associated retinal vessels dissociation, retinal whitening is seen. In a majority of cases with ONHA, the view of the fundus is obscured by vitreous hemorrhage. Ultrasonography can demonstrate a defect or hypolucency in optic nerve shadow.[1],[2] The disinsertion of the optic nerve head is more obvious on OCT, seen as a discontinuity between the retinal layers and optic nerve head.[3],[4] The clinically appreciable avulsion in this case is partial, as optic nerve sheath is intact. A complete disruption of third-order neurons with loss of vascular supply can account for the loss of perception of light. As there is no available treatment to restore continuity of the nerve fibers as well as vasculature, the visual prognosis remains dismal.

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Talwar D, Kumar A, Verma L, Tewari HK, Khosla PK. Ultrasonography in optic nerve head avulsion. Acta Ophthalmologica 2009;69:121-3.  Back to cited text no. 1
    
2.
Sawhney R, Kochhar S, Gupta R, Jain R, Sood S. Traumatic optic nerve avulsion: Role of ultrasonography. Eye (Lond) 2003;17:667-70.  Back to cited text no. 2
    
3.
Jain P, Gopalakrishnan M, Anantharaman G. Traumatic optic nerve head avulsion: Multimodal imaging. Indian J Ophthalmol 2018;66:1003.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Murchison AP, Affel EL, Garg SJ, Bilyk JR. Optical coherence tomography in optic nerve head avulsion. Orbit 2012;31:97-101.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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