Optic atrophy following eyelid injury.

Injury to the optic nerve leading to optic atrophy may be direct or indirect. Direct injury may result from laceration of the nerve fibres by a missile or sharp instrument penetrating the orbit, by a displaced fragment of bone in fracture of the optic canal, or by avulsion of the nerve at the globe. Indirect injury is well recognized in contusion injuries of the head, especially the brow, and is generally attributed to tearing of sub-arachnoid bloodvessels through movement of the nerve within its sheath, where this is attached to the bony optic canal (Traquair, 1929, 1945). An extensive personal series and the relevant literature were reviewed by Brodie Hughes (I962). Although damage to the optic nerve as a result of lid injury, particularly by a sharp and pointed instrument, is also well known, large series of lid injuries, together with eye injuries in children, have been documented without including any such cases (Werner, I952; Kobor, I965). When it does occur, it is generally accepted as being due to direct laceration of the nerve (Duke-Elder, 1954; Walsh, I957). Four cases of optic atrophy with complete unilateral blindness following wounds of the lower eyelids are presented. Although the immediate clinical picture is very different from forehead contusion, the optic atrophy follows a similar course. We suggest that the injury to the nerve may be similarly indirect, through tearing of blood vessels by its displacement in the bony canal, rather than through direct laceration.