Journal of Ophthalmology & Clinical Research Category: Clinical Type: Case Report
An Unusual Presentation of Optic Disc Drusen with Optic Nerve Avulsion
- Sait Alim1*, Selim Demir1, Erkan Gökçe2, Hüseyin Ortak1, Helin Deniz Demir1, Mehmet Esen3
- 1 Department Of Ophthalmology, Gaziosmanpasa University, Tokat, Turkey
- 2 Department Of Radiology, Gaziosmanpasa University, Tokat, Turkey
- 3 Department Of Emergency Medicine, Gaziosmanpasa University, Tokat, Turkey
*Corresponding Author:Sait Alim
Department Of Ophthalmology, Gaziosmanpasa University, Tokat, Turkey
Received Date: Jan 29, 2016 Accepted Date: Mar 30, 2016 Published Date: Apr 13, 2016
To evaluate the neuroimaging and clinical findings of complete optic nerve avulsion of a patient with optic disc drusen.
A 50-year-old woman presented with left eye anterolateral luxation and vision loss after injury by a crane lifting chain. Best corrected vision acuity, slit-lamp biomicroscopy, intraocular pressure, ocular ultrasonography and neuroimaging was carried out.
The fundus examination revealed right eye optic disc with drusen. Vitreous hemorrhage obscured the left eye fundus examination. Computerized Tomography of the patient showed that the left eye optic disc with drusen was far from the globe when compared with the right eye.
The diagnosis of optic nerve avulsion could be hard in some cases. Clinicians should keep in mind that in such cases if optic disc head contains drusen the diagnosis would be easier.
Optic disc drusen or optic disc head drusen are found about 2.4% in a necropsy study . About two thirds to three quarters of clinical cases are bilateral. Here we present a patient with bilateral optic disc with drusen who had a blunt trauma to his left eye by a crane lifting chain which caused complete optic nerve avulsion.
The patient was informed and written consent was obtained. Then, the patient was brought to the operating room. The globe tried to put back in the anatomic position. The medial rectus was severed 2 mm far from its insertion. Medial rectus was retracted beyond the globe so we could not find the distal part of it. Therefore the proximal part of the medial rectus sutured to the bone periosteum of medial wall of the globe. The remainder of other rectus muscles insertions was intact. But the superior rectus was stretched and so it folded over itself and sutured. In the end the upper eyelid was repaired. Postoperatively the globe was in anatomic position and the patient’s visual acuity was no light perception. Eye movements were restricted. The right eye examination was normal. It is a very rare case and to the best of our knowledge it is the first case evaluating optic disc head drusen with optic nerve avulsion.
Optic nerve drusen is de?ned as hyaline bodies that result from calci?cation of intracellular axonal mitochondria located in the prelaminar portion of optic nerve . B-scan US, a non-invasive diagnostic tool, is a reliable method for con?rming the presence of optic disc drusen . CT is also a useful method for diagnosis of optic disc drusen due to their calcium content.
Various diagnostic tests like MRI, CT scan, US and fundus fluorescein angiography have been used in diagnosis of optic nerve avulsion. These diagnostic tests could not always show the optic nerve avulsions. For this reason sometimes surgical exploration may needed for exact diagnosis of optic nerve avulsion. Roth et al.,  have described a patient with optic nerve avulsion who had trauma to his eyeball by the golf club. The CT scan of brain and orbits showed no abnormalities. Foster et al.,  carried out a study to find out the role of diagnostic imaging in patients with optic nerve avulsion. Neuroimaging including CT scan and MRI or both was done for six patients. Only in one case disinsertion of optic nerve from the globe was discovered. In two cases MRI could not reveal optic nerve avulsion. Complete optic nerve avulsion was seen just in one case when the globe was surgically explored. Therefore, it is usually hard to diagnosis optic nerve avulsion by CT scan and MRI. Our patient was also asked for orbital CT scan and MRI. Because of retrobulbar hemorrhage MRI findings was not helpful. Orbital CT scan revealed optic disc with drusen. While compared with the right eye the left eye optic disc with drusen was far from the globe (Figure 3). This finding leaded us to the diagnosis of complete optic nerve avulsion. US is also may be useful in diagnose of optic nerve avulsion. Prior studies of US have revealed encouraging results in diagnosis of optic nerve avulsion . Sawhney et al.,  had found that US of globe demonstrated hypoechoic defect in the posterior ocular coat showing complete avulsion in their two cases.
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Citation:Alim S, Demir S, Gökçe E, Ortak H, Demir HD, et al. (2016) An Unusual Presentation of Optic Disc Drusen with Optic Nerve Avulsion. J Ophthalmic Clin Res 3: 020.
Copyright: © 2016 Sait Alim, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.