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Case Reports
. 2022 Jun 16:27:101621.
doi: 10.1016/j.ajoc.2022.101621. eCollection 2022 Sep.

Globe dislocation and optic nerve avulsion following all-terrain vehicle accidents

Amro Omari  1   2 , Anaïs L Carniciu  2   3 , Maya Desai  1 , Olivia Schimmel  1 , Dianne M Schlachter  2   3 , Robert Folberg  1   2   4 , Alon Kahana  1   2   5
Affiliations
Case Reports

Globe dislocation and optic nerve avulsion following all-terrain vehicle accidents

Amro Omari et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: Open-air motor vehicles present unique trauma risks to the eyes and face. We describe two patients who suffered a crash while riding an all-terrain vehicle (ATV), leading to globe dislocation with optic nerve avulsion in order to raise awareness about the risks associated with ATV accidents.

Observations: In both cases, the injury was caused by high-speed trauma to the orbit involving a tree branch. One patient sustained a life threatening arrythmia requiring a short stay in the intensive care unit, and both patients required emergent surgical management and eventual socket reconstruction.

Conclusions and importance: These cases highlight the need for greater advocacy on behalf of rider safety. The authors encourage ophthalmologists to counsel patients who use ATVs to wear helmets, seatbelts, and protective eyewear to prevent these types of injuries in the future.

Keywords: All terrain vehicles; Globe dislocation; Optic nerve avulsion.

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Conflict of interest statement

The authors declare that there are no conflicts of interest, either financially or personally, regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Clinical photographs of the two patients obtained before enucleation and orbital washout. Fig. 1a. Case 1: External photograph of the patient's left eye at the time of emergency room presentation. The globe is entirely dislocated out of the orbit and supported by the left cheek. The avulsed portion of the optic nerve has rotated anteriorly and is admixed with vegetative matter. Fig. 1b. Case 2: External photograph of patient's left eye upon presentation. The optic nerve is seen hanging at the superior edge of the enucleated globe. The lateral rectus muscle was still partially attached, with the globe rotated onto the cheek.
Fig. 2
Fig. 2
Clinical photograph obtained after the enucleation with washout but before reconstruction with the dermis fat graft. There is conjunctival dehiscence most pronounced temporally and inferior forniceal shortening. There are no signs of infection.
Fig. 3
Fig. 3
Histopathology specimens from Case 1 show that the optic nerve was avulsed rather than cut by the tree matter. Both specimens have been stained with Hematoxylin and Eosin. Fig. 3a is a 2x image illustrating the intraocular portion of the optic nerve. This portion was unremarkable and attached to its insertion at the optic nerve head. Fig. 3b is a 4x image of the transected portion of the optic nerve, which was located 16 mm behind its insertion in the optic nerve head. In this section, the dural sheath is intact with no signs of penetrating laceration but there is no remaining nerve tissue.
Fig. 3
Fig. 3
Histopathology specimens from Case 1 show that the optic nerve was avulsed rather than cut by the tree matter. Both specimens have been stained with Hematoxylin and Eosin. Fig. 3a is a 2x image illustrating the intraocular portion of the optic nerve. This portion was unremarkable and attached to its insertion at the optic nerve head. Fig. 3b is a 4x image of the transected portion of the optic nerve, which was located 16 mm behind its insertion in the optic nerve head. In this section, the dural sheath is intact with no signs of penetrating laceration but there is no remaining nerve tissue.
See this image and copyright information in PMC

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