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PHOTO ESSAY
Year : 2023  |  Volume : 3  |  Issue : 1  |  Page : 229-230

Post-traumatic perineuraloptic nerve cyst: An incidental rare finding on radiological imaging


1 Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
2 Diagnostic and Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India

Date of Submission04-Mar-2022
Date of Acceptance05-Sep-2022
Date of Web Publication20-Jan-2023

Correspondence Address:
Seema Meena
Room No 3007, 3rd Floor, Academic Block, AIIMS, Jodhpur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_426_22

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  Abstract 


Keywords: Optic nerve cyst, optic neuropathy, trauma


How to cite this article:
Meena S, Bhatnagar KR, Rathore P, Tiwari S, Agrawal N, Jaisingh K. Post-traumatic perineuraloptic nerve cyst: An incidental rare finding on radiological imaging. Indian J Ophthalmol Case Rep 2023;3:229-30

How to cite this URL:
Meena S, Bhatnagar KR, Rathore P, Tiwari S, Agrawal N, Jaisingh K. Post-traumatic perineuraloptic nerve cyst: An incidental rare finding on radiological imaging. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:229-30. Available from: https://www.ijoreports.in/text.asp?2023/3/1/229/368218



A 13-year-old girl presented to an ophthalmology department with a chief complaint of vision loss in the left eye after she suffered trauma with a wooden stick 1.5 months ago. The patient consulted a local ophthalmologist, where she underwent primary lid repair for a wedge-shaped lid tear at the junction of medial one-third and lateral two-thirds of the lower lid in the left eye. On consecutive visits, the patient was diagnosed with post-traumatic optic neuropathy with vitreous hemorrhage, for which the patient was given intravenous 1 g methylprednisolone for 3 consecutive days, followed by oral steroids (1 mg/kg body weight) for 11 days. However, there was no improvement in the visual acuity.

On examination, visual acuity was 20/20 in the right eye, and no perception of light in the left eye. There was the presence of grade 3 relative afferent pupillary defect (RAPD) in the left eye. Slit-lamp evaluation of the right eye was normal. However, the left eye showed the presence of red blood cells (RBCs) in the anterior chamber, posterior subcapsular cataract (PSC), and retrolental RBCs. There was a media haze of grade 3 on fundus evaluation of the left eye. Therefore, left eye B scan ultrasonography was done, which showed the presence of vitreous hemorrhage and a well-defined, thin-walled cystic lesion through transmission attached to the anterior intra-orbital part of the optic nerve [Figure 1]. MRI was suggestive of a perineural cyst at the left optic nerve head (4 × 2.5 mm) lateral to the optic nerve, likely post-traumatic with the edematous appearance of the proximal intraconal optic nerve early disc edema with vitreous hemorrhage [Figure 2]. A neurosurgery opinion was sought for the same. However, no active surgical intervention was done because of poor visual prognosis in the left eye due to time-lapse.
Figure 1: The axial B scan (a) and color doppler (b) images of the left eye show a small anechoic avascular cystic lesion (arrowhead) with posterior acoustic enhancement along the lateral aspect of the retro-orbital portion of the optic nerve head (black arrow). Also seen are coarse internal echoes (long white arrows) within the vitreous suggestive of vitreous hemorrhage

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Figure 2: The axial (a), coronal (b), and oblique sagittal (c) heavily T2-weighted MR images of orbit show a small eccentrically located cyst at the left superolateral aspect of the intra-orbital portion of the left optic nerve (white arrow) immediately behind the globe, suggestive of a perineural cyst. Note the subtle T2 hyperintensity on the retro-orbital part of the left optic nerve (dashed white arrow). The left optic nerve appears edematous with effacement of peri-optic CSF space, better visualized by comparing the normal-appearing right optic nerve

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  Discussion Top


Orbital injuries are nowadays quite common and can have a varied presentation. An optic nerve cyst, whether spontaneous or congenital, is a rare clinical entity.[1],[2] Multiple etiologies have been described for the formation of optic nerve cysts. It includes arachnoid cysts, post-traumatic or postoperative cysts, neuroepithelial cysts, congenital cystic eye or microphthalmos with cysts involving the optic nerve, idiopathic causes, associations with meningiomas and meningocele.[3],[4],[5]

However, the development of post-traumatic perineural cysts lateral to the optic nerve after blunt trauma is rare. In our case, magnetic resonance imaging (MRI) was consistent with an arachnoid cyst of the optic nerve. There was no associated orbital wall fracture. Hence, it might be possible that entrapment of neuroepithelial cells during trauma might have led to cyst formation, or might be a loculated Cerebrospinal fluid (CSF) surrounded by fibrous proliferation as proposed by Akor et al.[5] Our case is unique as it highlights the importance of radiological imaging as the timely multidisciplinary approach may be amenable to visual rehabilitation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mehta VJ, Chelnis JG, Nickols HH, Mawn LA. Neuroepithelialcyst of the optic nerve in a newborn. Ophthalmic Plast Reconstr Surg 2017;33 (3S Suppl 1):S109-11.  Back to cited text no. 1
    
2.
Naqvi SM, Thiagarajah C, Golnik K, Lee A, Kersten R, Nerad J. Optic nerve cyst-like formation presenting as a delayed complication of optic nerve sheath fenestration. Ophthalmic Plast Reconstr Surg 2014;30:e53-4.  Back to cited text no. 2
    
3.
Lunardi P, Farah JO, Ruggeri A, Nardacci B, Ferrante L, Puzzilli F. Surgically verified case of optic sheath nerve meningocele: Case report with review of the literature. Neurosurg Rev 1997;20:201-5.  Back to cited text no. 3
    
4.
Moschos MM, Lymberopoulos C, Moschos M. Arachnoid cyst of the optic nerve: A case report. Klin Monbl Augenheilkd 2004;221:408-9.  Back to cited text no. 4
    
5.
Akor C, Wojno TH, Newman NJ, Grossniklaus HE. Arachnoid cyst of the optic nerve: Report of two cases and review of the literature. Ophthalmic Plast Reconstr Surg 2003;19:466-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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