A Case of Traumatic Optic Nerve Injury due to Gunshot

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.