Optic nerve avulsion
B. S. Foster, G. A. March, M. J. Lucarelli, N. Samiy and S. Lessell
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
OBJECTIVE: To characterize the presentation, role of diagnostic imaging,
and course in patients with optic nerve avulsion. METHODS: A retrospective
review of medical records of all 6 patients with optic nerve avulsion who
were seen at the Massachusetts Eye and Ear Infirmary, Boston, from January
1, 1991, to July 31, 1995. RESULTS: The initial visual acuity ranged from
20/100 to no light perception. All 6 patients underwent neuroimaging,
including computed tomography, magnetic resonance imaging, or both. B-scan
ultrasonography was performed on 4 patients, and the condition of 1 patient
was evaluated with color Doppler ultrasonography to assess the optic nerve
vasculature. In 1 patient, a computed tomographic scan was suggestive of an
optic nerve avulsion. Neuroimaging in the other 5 patients, including 2
patients who underwent magnetic resonance imaging, failed to demonstrate an
avulsion. During a follow-up period of up to 25 months, 4 patients showed
no improvement in visual acuity, 1 patient improved from no light
perception to bare light perception, and 1 patient improved from 20/100 to
20/25. CONCLUSIONS: These data suggest that final visual outcome was
dependent on initial postinjury visual acuity. Neuroimaging, B-scans, and
Doppler ultrasonography were usually not helpful in establishing the
presence of optic nerve avulsion, although they may be useful in evaluating
comorbid conditions.
