Clinical Ophthalmology (Sep 2023)

Optic Nerve Avulsion: Pattern and Etiologies at a Tertiary Eye Care Center in Saudi Arabia: An 8-Year Retrospective Study

  • Al Amry M,
  • AlHijji L,
  • Elkhamary SM,
  • Mousa A,
  • AlGaeed A,
  • AlGhadeer H

Journal volume & issue
Vol. Volume 17
pp. 2633 – 2641

Abstract

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Mohammad Al Amry,1 Lamia AlHijji,2 Sahar M Elkhamary,3 Ahmed Mousa,4 Abdulrahman AlGaeed,3 Huda AlGhadeer1 1Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 2Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3Radiology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 4Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Huda AlGhadeer, Emergency Department, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh, 11462, Saudi Arabia, Tel +966 1 4821234 extension 2500, Email [email protected]: Optic nerve avulsion (ONA) is a rare but serious presentation of ocular trauma. This study investigates the presenting characteristics and etiologies of all cases of ONA over an 8-year-period at a tertiary eye care center in the Middle East.Methods: The medical records of patients diagnosed with ONA at an Ophthalmic Emergency Department between November 2014 and November 2022 were analyzed in this retrospective cohort study. Data were collected on patient age, sex, affected eye, cause of injury and imaging studies. The best-corrected visual acuity (BCVA) at presentation and at the last follow-up visit, and the duration of follow-up were documented.Results: The study sample was comprised of 44 eyes of 43 patients with ONA with median age of 16.5 (9.3– 26.8) years ranging from 2 years old to 70 years old. There were (35;79.5%) males and (9; 20.5%) females. Most cases presented with an affected left eye (27; 61.4%) followed by the right eye (16; 36.4%) and only one patient (2.3%) had bilateral ONA. The most common cause of trauma resulting in ONA was a metallic object (8;18.2%). This study demonstrates the value of multi-sequence Magnetic resonance imaging (MRI) in the setting of unexplained vision loss when other modalities are inadequate or inconclusive.Conclusion: Ophthalmic morbidity resulting from ONA can be devastating. Metallic object injuries were the most prevalent cause of ONA. The presence of associated media opacities challenges the initial diagnosis of ONA. In the vast majority of cases, the vision ended as no light perception (NLP), indicating permanent vision impairment.Keywords: avulsion, ocular, optic nerve, trauma

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