Traumatic optic nerve head avulsion anterior to the lamina cribrosa in a child: a case report.
- 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
- 2Department of Ophthalmology, Shenzhen Nanshan People's Hospital, Shenzhen, China.
- 3School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China.
Abstract
Optic nerve head avulsion (ONA) is a rare and devastating complication of ocular trauma, typically involving the retraction of the optic nerve behind the ocular wall. While posterior ONA is well-documented, cases occurring anterior to the lamina cribrosa have not been previously reported. We present a unique case of anterior ONA associated with total retinal detachment (RD). A 4-year-old boy presented with no light perception (NLP) in his left eye after blunt ocular trauma in a fall down a staircase. Initial B-scan ultrasonography and orbital computed tomography (CT) scans revealed vitreous hemorrhage and RD but no obvious retrobulbar optic nerve discontinuity. During pars plana vitrectomy, a total RD with a large peripheral retinal tear was identified. The optic nerve head was absent from its expected anatomical position, with no recognizable prelaminar optic nerve tissue overlying the exposed, intact-appearing lamina cribrosa, supporting complete ONA anterior to the lamina cribrosa. Partial retinal reattachment was achieved using endolaser photocoagulation and silicone oil tamponade. The patient's vision remained NLP on postoperative day 1, and no longer-term follow-up was available. This case illustrates that ONA at the prelaminar level may not be definitively identified by preoperative ultrasonography or CT, particularly with dense vitreous hemorrhage and associated RD. ONA should therefore be considered in the differential diagnosis of profound visual loss after blunt ocular trauma even when preoperative imaging shows no retrobulbar optic nerve discontinuity.
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BibTeX
@article{li2026traumatic,
title = {{Traumatic optic nerve head avulsion anterior to the lamina cribrosa in a child: a case report.}},
author = {Mingge Li and Yanxian Chen and Liwen He},
journal = {Translational pediatrics},
year = {2026},
month = oct,
doi = {10.21037/tp-2026-0722},
url = {https://europepmc.org/article/MED/42996414},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Traumatic optic nerve head avulsion anterior to the lamina cribrosa in a child: a case report.
AU - Mingge Li
AU - Yanxian Chen
AU - Liwen He
PY - 2026
DA - 2026/10/16
JO - Translational pediatrics
DO - 10.21037/tp-2026-0722
UR - https://europepmc.org/article/MED/42996414
AB - Optic nerve head avulsion (ONA) is a rare and devastating complication of ocular trauma, typically involving the retraction of the optic nerve behind the ocular wall. While posterior ONA is well-documented, cases occurring anterior to the lamina cribrosa have not been previously reported. We present a unique case of anterior ONA associated with total retinal detachment (RD). A 4-year-old boy presented with no light perception (NLP) in his left eye after blunt ocular trauma in a fall down a staircase. Initial B-scan ultrasonography and orbital computed tomography (CT) scans revealed vitreous hemorrhage and RD but no obvious retrobulbar optic nerve discontinuity. During pars plana vitrectomy, a total RD with a large peripheral retinal tear was identified. The optic nerve head was absent from its expected anatomical position, with no recognizable prelaminar optic nerve tissue overlying the exposed, intact-appearing lamina cribrosa, supporting complete ONA anterior to the lamina cribrosa. Partial retinal reattachment was achieved using endolaser photocoagulation and silicone oil tamponade. The patient's vision remained NLP on postoperative day 1, and no longer-term follow-up was available. This case illustrates that ONA at the prelaminar level may not be definitively identified by preoperative ultrasonography or CT, particularly with dense vitreous hemorrhage and associated RD. ONA should therefore be considered in the differential diagnosis of profound visual loss after blunt ocular trauma even when preoperative imaging shows no retrobulbar optic nerve discontinuity.
SN - 2224-4336
SN - 2224-4344
ER -