Paintball trauma and mechanisms of optic nerve injury: rotational avulsion and rebound evulsion.

PURPOSE Ballistic impact studies and supercomputer modeling were performed to elicit the mechanisms of optic nerve rupture that may accompany blunt ocular trauma. METHODS Paintball ocular impact responses were studied with abattoir-fresh porcine eyes. Physics-based numerical code CTH was used to produce robust geometric and constitutive models of the eye and orbit, providing a comparative 3-D finite volume model to help determine the mechanisms underlying empirical ballistic observations. RESULTS Among 59 porcine eye specimens submitted to paintball impact in the 1- to 13-J range, 10 (17%) disengaged completely from the orbital mount. In each instance the paintball penetrated the orbit adjacent to the globe, producing rotation and eventual globe repulsion, dramatically evident on high-speed film images. Supercomputer modeling yielded similar globe-expulsive results when orbital constraints were in place, but not when these were removed. In these models, tangential (grazing) impact sheared the nerve flush with the globe via a strain rate effect within 260 μs, with minimal posterior displacement and just 5° of globe rotation. Midperipheral impact produced compressive globe distortion and posterior displacement, followed by rebound and tractional nerve avulsion 10 mm behind the lamina after 700 μs and 20° of globe rotation. CONCLUSIONS Constitutive modeling studies suggest at least two trajectory-dependent mechanisms for optic nerve rupture with paintball impact on the eye. Tangential glancing blows produce strain-rate rotational avulsion, abscising the optic nerve with minimal internal globe disruption, whereas off-center direct impact produces slower rotational-rebound evulsion, traumatizing the globe and breaching the nerve posteriorly. The latter mechanism would be expected to arise more commonly and would most likely be clinically masked by accompanying intraocular injury.