Optic Neuropathy with Delayed Onset After Trauma: Case Report and Review of the Literature

Abstract

We report a case of a 16 year-old healthy male, who experienced loss of vision in the right eye immediately after getting punched by a fist. His visual acuity improved to 20/20 within hours, and the optic nerve head appeared normal. CT scan of the orbits showed fractures of the right inferior orbital wall and lamina papyracea. The morning after the injury, he awoke with right eye vision decline to count fingers. There was pallid optic nerve swelling. MRI scan of the orbits showed right medial rectus enlargement and no optic canal abnormalities. The patient was treated with IV methylprednisolone with improvement in visual acuity. Literature of delayed traumatic optic neuropathy (TON) and anterior TON is reviewed.

Keywords: Optic Neuropathy; Steroid; Trauma.

Figure 1.

Fundus photograph of the right eye illustrating diffuse optic disc elevation with pallor.

Figure 2.

MRI of the orbit (axial T1) post-contrast demonstrating enlarged right medial rectus, intact optic canal, and a right posterior medial orbital wall fracture.

Figure 3.

(a) Goldmann visual field of the right eye illustrating severe constriction, worse inferonasally and superotemporally. (b) Goldmann visual field of the right eye at 6-month follow-up illustrating nasal and inferior constriction, improved from prior.