Optic nerve avulsion

Objective: To characterize the presentation, role of diagnostic imaging, and course in patients with optic nerve avulsion. Methods: A retrospective review of medical records of all 6 patients with optic nerve avulsion who were seen at the Massachusetts Eye and Ear Infirmary, Boston, from January 1, 1991, to July 31, 1995. Results: The initial visual acuity ranged from 20/100 to no light perception, All 6 patients underwent neuroimaging, including computed tomography, magnetic resonance imaging, or both. B-scan ultrasonography was performed on 4 patients, and the condition of 1 patient was evaluated with color Doppler ultrasonography to assess the optic nerve vasculature. In 1 patient, a computed tomographic scan was suggestive of an optic nerve avulsion. Neuroimaging in the other 5 patients, including 2 patients who underwent magnetic resonance imaging, failed to demonstrate an avulsion. During a follow-up period of up to 25 months, 4 patients showed no improvement in visual acuity, 1 patient improved from no light perception to bare light perception, and 1 patient improved from 20/100 to 20/25. Conclusions: These data suggest that final visual outcome was dependent on initial postinjury visual acuity. Neuroimaging, B-scans, and Doppler ultrasonography were usually not helpful in establishing the presence of optic nerve avulsion, although they may be useful in evaluating comorbid conditions.