DR. SHYAM SUNDAR DAS MOHAPATRA

Abstract

A 8-year-old male presented with no perception of light (PL) after sustaining injury with bamboo stick to right eye (OD). Grade 4 right afferent pupillary defect, normal IOP, periorbital ecchymosis, upper eyelid and conjunctival laceration, subconjunctival hemorrhage and mild iritis were noted. Funduscopy revealed avulsion of optic nerve head (ONH) in OD with vitreous hemorrhage (VH) overlying the ONH and inferiorly with retinal edema. Ultrasound (USG) B Scan and visual evoked potential (VEP) were performed, which confirmed avulsion of right ONH. Eyelid and conjunctival lacerations sutured under general anesthesia. Two weeks later, there was still no PL in OD. ONH avulsion is a rare complication of blunt ocular trauma. ONH avulsion should be suspected in all cases with sudden severe visual loss and dense VH following blunt trauma. ONH avulsion poses with significant diagnostic challenge in the presence of VH. USG is a inexpensive and readily available tool to diagnose ONH avulsion.