gms | German Medical Science

Background: Optic nerve avulsion (ONA) is an uncommon presentation of ocular trauma. It is characterized by traumatic disinsertion of the nerve fibres from the globe. ONA can occur completely or partially. We report the long-term follow-up in children with ONA due to traumatic events. The remarkable differences in course and outcome may elucidate the spectrum associated to ONA.

Methods: During the last fifteen years, three children with ONA were referred to our clinic. These case reports are presented with special attention to the long-term follow-up.

Results: Two patients suffered from complete ONA after head injury. The third patient presented with a partial ONA caused by a bicycle accident. Long-term follow-up of the patients varied between seven and fifteen years. In the first patient, a pale swollen retina without any visible retinal vasculature initially occurred. The retina completely detached in the course. In the second patient, extended fibroglial scarring occurred. The enormous epiretinal membrane formation finally teared off spontaneously into the vitreous. The third patient developed only few fibroglial scarring and mild retinal pigment epithelium hyperplasia. The optic nerve head finally resembled a morning glory like disk.

Conclusions: Mechanisms of ONA are not completely understood yet. The most distal part of the optic nerve might be especially vulnerable because of missing myelinisation and only fine arachnoid suspension. Patients with ONA can adopt different courses and outcomes. Individual final visual outcome seems to depend on the first visual acuity measured after injury. Substantial intraocular architecture changes can occur due to ONA.