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Photo Essay |

Ultrasonographic Signs in Complete Optic Nerve Avulsion

Scott C. N. Oliver, MD; Naresh Mandava, MD
Arch Ophthalmol. 2007;125(5):716. doi:10.1001/archopht.125.5.716.
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A 13-year-old boy sustained injury with a metal pipe to his right eye. The patient had no light perception in his right eye and visual acuity was 20/25 OS. A 4+ right afferent pupillary defect, normal intraocular pressures, chemosis, subconjunctival hemorrhage, and iritis were seen.

Dilated funduscopy (Figure 1) revealed avulsion of the right optic nerve and temporal retina. Vascular boxcarring was laid over pale, edematous retinal tissue. A dense hemorrhage obscured the nasal fundus.

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Figure 1.

Fundus photograph of the right eye revealed a pit where the avulsed optic nerve should be (asterisk), a pale edematous retina (arrow), an exposed bare sclera (dot), vascular boxcarring, intraretinal and preretinal blood, and a vitreous hemorrhage (arrowheads).

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Figure 2.

Horizontal B-scan ultrasound shows a retinal step sign from an edematous retina (arrow) to bare sclera (dot), a vitreous hemorrhage (arrowhead), and retraction of the edematous optic nerve into its sheath posterior to the lamina cribrosa (star). Each scale mark equals 5 mm.

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Figure 3.

Vertical B-scan ultrasound shows an edematous retina (arrows), a vitreous hemorrhage (arrowhead), a full-thickness lamina cribrosa defect (asterisk), and retraction of the avulsed optic nerve (star). Each scale mark equals 5 mm.

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Figure 4.

Fundus photograph at 5-month follow-up demonstrates arterial attenuation, possible retinal-choroidal venous anastomoses, retinal pigment epithelium hyperplasia, and fibroglial scarring from the posterior scleral outlet into the vitreous.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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