Optic nerve avulsion and central retinal artery occlusion after penetrating orbital injury

PURPOSE: To highlight a rare mechanism of optic nerve avulsion and central retinal artery occlusion secondary to penetrating orbital trauma, and to review the clinical and diagnostic findings that facilitate accurate identification of this uncommon pathology. METHODS: The patient underwent an extensive ophthalmic examination, including wide-field fundus photography, fluorescein angiography, and transpalpebral B-scan ultrasonography. RESULTS: A 9-year-old male presented with sudden vision loss following penetrating trauma to the left upper eyelid caused by a metal rod. Ophthalmologic examination revealed visual acuity limited to light perception and a linear wound in the left upper eyelid. Fundus examination showed peripapillary and perimacular hemorrhages, retinal pallor, and a cherry-red spot at the macula. Fluorescein angiography demonstrated delayed filling and blockage phenomenon at the peripapillary and perimacular levels, while transpalpebral ultrasound revealed a hypoechoic area in the sub-Tenon's space at the site of optic nerve exit. Given the poor visual prognosis, the patient was not considered a candidate for surgical intervention. CONCLUSION: This report describes an unusual case of optic nerve avulsion and central retinal artery occlusion following penetrating orbital trauma. Imaging modalities such as ultrasonography, computed tomography, and fluorescein angiography are critical for diagnosis in cases where direct ophthalmologic examination is limited by media opacity.