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© 2017 Journal of ophthalmic and Vision research | published by Wolters KluWer - medKnoW 351
A seven‑year‑old male patient with sudden onset loss of
vision in the left eye immediately after blunt trauma to the
left eye following a fall from stairs presented to us three
days after the trauma. History of epistaxis was present,
although there was no history of loss of consciousness,
vomiting, or convulsions. On examination, the left eye
had a subconjunctival hemorrhage. Orbital emphysema
was absent. The anterior segment examination and
intraocular pressure of both eyes was normal. The patient
had sustained a closed globe injury (CGI) with no full
thickness defect in the cornea or sclera. Direct pupillary
light reex in the left eye and consensual reex in the
right eye were absent. Ocular movements were normal;
there was no proptosis or enophthalmos on the left side.
Vision was 6/6 in the right eye and no perception of
light (NPL) in the left eye. Fundus of the right eye was
normal. Fundus of the left eye showed whitening of the
retina, segmentation of blood columns in the vessels
with cherry red spot and blood “spurting out” from the
Acute Vision Loss Due to Central Retinal Arterial
Occlusion, Partial Optic Nerve Avulsion, and
Hemorrhage “Spurting Out” from Optic Disc after Blunt
Trauma
Koushik Tripathy, MD; Babulal Kumawat, MD; Rohan Chawla, MD, FRCS (Glasg); Yog Raj Sharma, MS
Ravi Bypareddy, MD
Unit I, Department of Retina and Uvea, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences,
New Delhi, India
Photo Essay
Correspondence to:
Koushik Tripathy, MD. Department of Retina and Uvea,
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All
India Institute of Medical Sciences, New Delhi 10029, India.
E‑mail: koushiktripathy@gmail.com
Received: 09‑10‑2015 Accepted: 20‑02‑2016
optic disc obscuring disc details [Figure 1]. There was
no retinal tear visible in the retina. Ultrasound (USG) of
the left eye did not reveal any discontinuity in the optic
nerve. Fundus uorescein angiogram (FFA) showed
delayed lling of retinal arterioles, delayed arteriovenous
How to cite this article: Tripathy K, Kumawat B, Chawla R, Sharma YR,
Bypareddy R. Acute vision loss due to central retinal arterial occlusion,
partial optic nerve avulsion, and hemorrhage “Spurting Out” from optic
disc after blunt trauma. J Ophthalmic Vis Res 2017;12:351-2.
This is an open access article distributed under the terms of the Creative
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J Ophthalmic Vis Res 2017; 12 (3): 351‑352
Access this article online
Quick Response Code: Website:
www.jovr.org
DOI:
10.4103/jovr.jovr_4_15
Figure 1. Color fundus photograph of the left eye showed
whitening of the retina, segmentation of blood columns in the
vessels with cherry red spot and blood “spurting out” from
the optic disc obscuring disc details.
Photo Essay; Tripathy et al
352 Journal of ophthalmic and Vision research Volume 12, Issue 3, July-september 2017
transit time, with normal choroidal perfusion in the left
eye [Figure 2]. Provisional diagnosis of traumatic optic
neuropathy (TON), vitreous hemorrhage, and central
retinal arterial occlusion (CRAO) in the left eye was
made with a strong suspicion of associated optic nerve
avulsion (ONA). Computed tomography (CT) of the
brain and orbit showed small fractures in the medial and
inferior orbital wall with herniation of fat, although no
muscle entrapment was noted. There was no visible optic
nerve damage, but the left optic nerve was reported to be
tortuous. The hemoglobin electrophoresis was normal.
Vision in the left eye did not improve despite digital
massage and oral acetazolamide. After three months,
the eye remained NPL with optic atrophy, attenuation of
vessels, and old vitreous hemorrhage. Nasally, the optic
disc showed a crescent suggesting partial ONA [arrow
in Figure 3].
DISCUSSION
Central retinal arterial occlusion is rarely observed after
blunt ocular trauma. Post‑traumatic CRAO may be
associated with TON, optic nerve avulsion,[1] or central
retinal venous occlusion resulting in immediate vision
loss up to NPL. Here, the authors report a patient with
CRAO and vitreous hemorrhage in whom partial ONA
was detected at follow‑up, although ocular USG and
CT of the brain and orbit failed to detect ONA. CRAO
has been rarely reported in CGI, either in isolated
cases or associated with sickle cell hemoglobinopathy,
systemic lupus erythematosus, orbital emphysema, or
carotid cavernous stula; and in many cases of ONA.[1,2]
ONA can be both partial and complete, which may be
observed after blunt ocular trauma presumably due
to sudden rotation of the globe, anterior displacement
of the globe, or rise in intraocular pressure leading to
separation of the optic nerve from ocular coats.[3] FFA
can show normal, partial, or absent lling or retinal
vasculature in ONA along with late lling of veins.[3]
Gliosis is common after ONA, which may close a partial
ONA.[4] Imaging including USG, CT, and magnetic
resonance imaging may help in conrming the diagnosis
and ruling out other associated injuries, although ONA
may be missed.[4] ONA should be looked for in all cases
of severe vision loss after trauma, with CRAO along
with hemorrhage “spurting out” from the optic disc,
even though imaging may be inconclusive.
Acknowledgments
We are grateful to Trina Sengupta Tripathy for her
immense support in preparing the manuscript.
Financial Support and Sponsorship
Nil.
Conicts of Interest
There are no conicts of interest.
REFERENCES
1. Chong CC, Chang AA. Traumatic optic nerve avulsion and central
retinal artery occlusion following rugby injury. Clin Experiment
Ophthalmol 2006;34:88‑89.
2. Sawhney R, Kochhar S, Gupta R, Jain R, Sood S. Traumatic optic
nerve avulsion: Role of ultrasonography. Eye (Lond) 2003;17:667‑670
3. Roberts SP, Schaumberg DA, Thompson P. Traumatic avulsion
of the optic nerve. Optom Vis Sci 1992;69:721‑727.
4. Foster BS, March GA, Lucarelli MJ, Samiy N, Lessell S. Optic
nerve avulsion. Arch Ophthalmol 1997;115:623‑630.
Figure 2. Fundus uorescein angiogram showed delayed lling
of retinal arterioles, delayed arteriovenous transit time, with
normal choroidal perfusion in the left eye.
Figure 3. At one month follow‑up, the left eye showed optic
atrophy, attenuation of vessels, and old vitreous hemorrhage.
Nasally, the optic disc showed a crescent (arrow) suggesting
partial optic nerve avulsion.
