11/112. Major orbital complications of endoscopic sinus surgery.BACKGROUND: The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. methods: A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. RESULTS: All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. CONCLUSION: Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.- - - - - - - - - - ranking = 1keywords = optic (Clic here for more details about this article) |
12/112. Indirect traumatic optic neuropathy--two case report.The aim of the study was to evaluate the treatment of indirect traumatic optic neuropathy (ITON). ITON is defined as traumatic loss of vision that occurs without external or initial ophthalmoscopic evidence of injury to the eye or its nerve. The optimal management of ITON remains controversial. history, clinical findings and treatment of two cases of ITON with high-dose corticosteroids are described. Improvement of visual acuity after treatment with high-dose corticosteroids was achieved in both cases. The treatment is evaluated in comparison to endorsed treatment modalities found in literature. We concluded that was clinically reasonable to decide to treat or not to treat the indirect optic neuropathy on an individual patient basis.- - - - - - - - - - ranking = 6keywords = optic (Clic here for more details about this article) |
13/112. Management of traumatic optic neuropathy.Visual loss caused by trauma to the optic nerve is a well-recognized sequela to cranio-maxillofacial trauma. The authors reviewed their experience with 90 patients with pure traumatic optic neuropathy and optic nerve trauma with concomitant maxillofacial injuries. All patients were treated with intravenous steroids. Those not improving underwent extracranial optic canal decompression. patients with initial visual acuity of 20/100 or better all responded favorably with improvement in visual acuity or visual field to a course of intravenous megadose corticosteroids. patients with initial vision of 20/200 or worse who failed to respond to corticosteroids may have improved visual function after undergoing extracranial optic canal decompression. Preoperative and postoperative computed tomography scans on 6 patients enhanced with intrathecal iopamidol indicate the site of optic nerve compression to be at the optic canal. This article discusses the diagnosis and the medical and surgical treatment of pure and complex optic nerve injuries.- - - - - - - - - - ranking = 12keywords = optic (Clic here for more details about this article) |
14/112. Complete avulsion of the optic nerve. A clinical, angiographic, and electrodiagnostic study.A case of traumatic complete avulsion of the optic nerve is reported together with fluorescein angiography and electrodiagnostic findings. Despite the disappearance of the central vessels, circulation remained in the branch retinal vessels and angiography demonstrated communication between peripapillary choroidal vessels and the superior temporal artery. The visually-evoked cortical response was abolished. electroretinography showed a normal a-wave but reduced amplitude b-wave, not supporting the theory of the existence of centrifugal retino-suppressive fibres in the optic nerve of man.- - - - - - - - - - ranking = 6keywords = optic (Clic here for more details about this article) |
15/112. Traumatic evulsion of the globe.PURPOSE: To report the clinical and pathologic findings in 3 cases of traumatic evulsion of the globe, during which the optic nerve and its sheath were disrupted at different locations and to varying extents. methods: Case series (3 patients). RESULTS: We describe the clinical, gross, and microscopic pathologic findings in 3 globes that were traumatically evulsed from their orbits. The optic nerves and sheaths were disrupted at 2 different locations and in 2 distinct combinations. Two of these variations in discontinuity of the nerve and/or its sheath were unique. In 1 case, the eye and optic nerve sheath were evulsed without the nerve; in another case, the nerve and sheath were pulled from the posterior sclera at the lamina cribrosa. CONCLUSIONS: Traumatic evulsion of the globe may cause the optic nerve and its sheath to be disrupted at varying distances from the eye and may involve the optic nerve and its sheath together or separately. To the best of our knowledge, no cases have been reported in which orbital trauma caused the globe and optic nerve sheath to be removed together, leaving the nerve behind, or in which disruption of the optic nerve at the lamina cribrosa resulted in a complete posterior scleral defect. Three theories are proposed to explain possible mechanisms leading to optic nerve disruption during traumatic evulsion of the globe.- - - - - - - - - - ranking = 8keywords = optic (Clic here for more details about this article) |
16/112. Evolution of descending optic atrophy. A case report.Fundus changes following severe trauma to the intracranial optic nerve were followed by means of serial fundus photography. The eye was completely blind. Little change was seen during the first 4 weeks. The retinal nerve fibre layer disappeared gradually during weeks 4 to 8. At the same time the retinal vessels turned narrow, and vascular pseudo-sheathing appeared close to the optic disc.Disc pallor was not maximal until the 12th week, when the peripapillary retina also had acquired a mottled appearance.- - - - - - - - - - ranking = 6keywords = optic (Clic here for more details about this article) |
17/112. Self-inflicted repetitive optic nerve injury: a case report.PURPOSE: To describe an obsessive-compulsive patient who developed blindness after self-inflicted repetitive optic nerve injury. methods: Case report. RESULTS: A myopic 46-year-old male became blind as a result of intermittent rubbing of his eyes, causing stretching of the optic nerves. Extensive ocular, neurologic and systemic work-ups were negative. Cerebral and orbital MR studies showed severe bilateral optic nerve atrophy. Psychiatric evaluation confirmed obsessive-compulsive personality. CONCLUSIONS: Self-inflicted optic nerve injury should be included in the differential diagnosis of progressive optic neuropathy in a young adult.- - - - - - - - - - ranking = 9keywords = optic (Clic here for more details about this article) |
18/112. Optic neuropathy resulting from indirect trauma.Minor blunt injury to the head and face may result in optic nerve contusion with secondary optic atrophy. The resulting visual loss is devastating for the individual. We report an uncommon but important complication that may result from an apparently trivial injury. Early identification and initiation of appropriate management may restore the individual's vision. Emergency physicians are often the first to see patients at risk of this complication yet there is little discussion of this injury in the emergency medicine literature.- - - - - - - - - - ranking = 2keywords = optic (Clic here for more details about this article) |
19/112. Axonal loss after traumatic optic neuropathy documented by optical coherence tomography.PURPOSE: To report longitudinal retinal nerve fiber layer (RNFL) thickness measurements using optical coherence tomography (OCT) in a patient with traumatic optic neuropathy. DESIGN: Observational case report. methods: A 14-year-old boy with severe optic nerve trauma had repeated OCT scans of the peripapillary retinal nerve fiber layer at 3 days, 20 days, 40 days, and 70 days after injury. RESULTS: There was gradual loss of nerve fibers as shown by the OCT color-coded map, RNFL thickness profile, and RNFL thickness measurements around the optic disk. At 70 days of follow-up, severe thinning of the RNFL was observable. CONCLUSIONS: These findings suggest that OCT is able to assess and monitor axonal loss after traumatic optic neuropathy.- - - - - - - - - - ranking = 13keywords = optic (Clic here for more details about this article) |
20/112. Attempted bilateral manual enucleation (gouging) during a physical assault.OBJECTIVE: To report a rare, severe case of partial traumatic bilateral enucleation and its assessment and management. DESIGN: Case report and literature review. methods: A report of clinical and imaging findings, surgical procedure, medical treatment, and final outcome. RESULTS: Complete avulsion of the extraocular muscles and optic nerve resulted in total loss of vision in one eye. Partial visual recovery was achieved by operating on the fellow eye, which was partially avulsed. Both eyes underwent lateral canthotomy in the emergency room. This was followed by exploration, repair of all ruptured extraocular muscles, and anterior chamber tap under general anesthesia. The few previously reported cases of traumatic manual avulsion of the globe are reviewed and discussed in the context of the present case. CONCLUSIONS: Partial visual recovery can be achieved after severe orbital and optic nerve trauma. A multidisciplinary approach to the assessment and management of these patients is recommended.- - - - - - - - - - ranking = 2keywords = optic (Clic here for more details about this article) |
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