Korean J Ophthalmol.  2010 Apr;24(2):134-138. 10.3341/kjo.2010.24.2.134.

Traumatic Optic Neuropathy Accompanying Orbital Grease Gun Injury

• Park JH
• Jang JW
• Kim SJ
• Lee YJ

• KMID: 946008
• DOI: http://doi.org/10.3341/kjo.2010.24.2.134

Abstract

We report a case of traumatic optic neuropathy accompanying a grease gun injury to the orbit. A 48-year-old man with a grease gun injury visited our clinic with decreased visual acuity, proptosis and limited extraocular movement (EOM). Orbital CT revealed a crescent mass of fat in the medial intraconal space. The grease was exuded from a lacerated conjunctival wound. The visual evoked potential (VEP) test demonstrated a decreased response in the left eye. Proptosis and EOM were improved after surgical removal of the grease. Systemic high-dose corticosteroid therapy was administered for suspected traumatic optic neuropathy, after which VEP nearly recovered, while visual acuity was slightly improved. A second surgery for traumatic cataract did not further improve visual acuity.

Keyword

Optic nerve diseases; Orbit; Penetrating eye injuries

MeSH Terms

*Accidents, Occupational
Evoked Potentials, Visual
Eye Injuries, Penetrating/diagnosis/*surgery
Humans
*Lubricants
Male
Optic Nerve Injuries/diagnosis/*surgery
Orbit/*injuries
Visual Acuity

Figure

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  Fig. 1 Appearance just after the accident showing eyelid swelling, chemosis and extreme limitations of extraocular movement (EOM) in all directions.

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  Fig. 2 Solidified grease (arrow heads) extruded from the conjunctival laceration wound.

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  Fig. 3 Orbital CT just after the accident. The globe is laterally deviated by a low-attenuated crescent-shaped area (-109 HU, arrow heads) in the medial intraconal space. The volume effect of this area causes proptosis, which results in distortion of the posterior part of the globe (arrow) and optic nerve extension. Bony structures and extraocular muscles appear intact.

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  Fig. 4 Solidified grease surgically removed from the intraconal area through the conjunctival wound.

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  Fig. 5 MRI 1 month after the surgical removal of the grease. Multiple bubble-like cystic lesions (arrows) are surrounded by enhancing areas presumed to be inflammatory reactions (arrow heads) to foreign bodies. Adjacent rectus muscles look slightly compressed. On the T1-weighted image (A), cystic lesions show high signal intensity which resembles that of intraconal fat. On the T2-weighted image (B), the lesions are difficult to distinguish from the surrounding area because of similar low signal intensities. On the fat saturation images (C, D), on the other hand, both the cystic and surrounding lesions are well demarcated and distinguished from the intraconal fat.

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  Fig. 6 Appearance 3 months after the surgical removal of grease showing markedly improved extraocular movement and proptosis in the left eye. Limitation in the medial gaze is still shown.

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