DOI: 10.36347/SJMCR.2019.v07i11.002

Pages: 649-652

Optic nerve injury is a rare complication of head trauma, occurring in 0.5% to 5.0% of all traumatic head injuries. We report a case of bilateral proptosis and optic nerve stretching following blunt head injury. We present a unique case of a 31 year old male who sustained traumatic head injuries after being hit by a train. He had contusions in the frontal lobes in conjunction with posttraumatic subarachnoid and intraventricular hemorrhage. In addition to suffering from extensive maxillary facial and orbital fractures involving maxillary sinuses, superior alveolar ridge, frontal sinuses, and nasal bone, he also had bilateral proptosis and optic nerve stretching. His optic nerve injuries were managed conservatively. A left frontal decompression craniotomy and evacuation was performed for refractile intracranial hypertension. Subsequently he was discharged to a long term rehabilitation facility with a GCS score of 11. Optic nerve injuries can occur due to primary axonal damage at the time of impact or due to secondary mechanisms involving edema and compression. Optic nerve injuries may easily be overlooked during initial evaluation of severe head and multisystem trauma, but techniques such as the swinging flashlight test and visual evoked potential help evaluate the extent of these injuries. Although the prognosis depends on the initial visual acuity on presentation, the treatment for optic nerve injury includes observation, medical treatment with high dose steroids, and surgical approaches such as decompression of the optic canal and nerve sheath fenestrations. There is no significant benefit of surgical management over observation alone. Optic nerve injury can easily be overlooked in post-traumatic patients with severe head injuries or altered metal status. Proper evaluation, timely diagnosis and appropriate treatment can potentially improve the long term outcome in such patients.