J Korean Ophthalmol Soc.  2008 Jan;49(1):177-182. 10.3341/jkos.2008.49.1.177.

A Case of Traumatic Optic Nerve Injury due to Gunshot

• Park JH
• Chang SD
• Lee SY

• KMID: 2211203
• DOI: http://doi.org/10.3341/jkos.2008.49.1.177

Abstract

PURPOSE: There have been no reports of optic nerve injuries caused by gunshot in Korea. We describe such an injury and report the treatment outcomes.
CASE SUMMARY
A patient visited our hospital complaining of visual disturbance after her right zygomatic bone had been shot with an airgun during a suicide attempt in September 2006. A visual acuity test, pupillary light reflex test, fundus examination, skull X-ray, and computed tomography (CT) were performed. At the initial examination, the right eye had no light perception. The pupillary light reflex test revealed an afferent pupillary defect, and the fundus examination showed central retinal artery occlusion. The skull X-ray and computed tomography revealed a fracture of the right medial and lateral orbital walls as well as a partial injury to the medial rectus muscle. In addition, right retrobulbar hemorrhage and metallic foreign bodies were observed in the right orbit. Under general anesthesia, disinsertion of the superior and lateral rectus muscles was performed, and the metallic foreign bodies in the right orbit were removed. The surgical incision was then closed. A Krimsky prism test performed 7 days after surgery revealed an approximately 15 prism diopters of exodeviation of the right eye.
CONCLUSIONS
We report a case of optic nerve injury caused by a gunshot.

Keyword

Exotropia; Gunshot; Metallic foreign bodies; Optic nerve injury

MeSH Terms

Anesthesia, General
Exotropia
Eye
Foreign Bodies
Humans
Korea
Light
Muscles
Optic Nerve
Optic Nerve Injuries
Orbit
Pupil Disorders
Reflex
Retinal Artery Occlusion
Retrobulbar Hemorrhage
Skull
Suicide
Visual Acuity

Figure

• 

  Figure 1. Fundus photograph of the right eye. One day after surgery, a cherry-red spots on the macula was detected, and a whitish-pale retina was seen in the vicinity of the superotemporal arcade (A). Seven days after surgery, a focal narrowing of the blood vessels from the optic disc in the temporal direction as well as macular degeneration was observed (B).

• 

  Figure 2. A large number of scattered metallic foreign bodies were detected from the left infratemporal fossa to the right temporal region (A). The metallic foreign bodies were detected in the right retrobulbar region, and an optic nerve injury was suspected. A fracture of the right medial orbital wall was detected, and a partial injury to the medial rectus muscle was suspected (B). A fracture of the right lateral wall was deteted, but no injury to the lateral rectus muscle was seen (C).

• 

  Figure 3. Mild limitation of adduction was noted 7 days after surgery (OD).

Reference

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