DDx
Differential Diagnoses
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Ischemic Optic Neuropathy
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Optic Nerve Avulsion
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Optic Nerve Inflammation
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Optic Nerve Sheath Hematoma
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Orbital Hematoma
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Sinusitis With Orbital Involvement
Media Gallery
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Plain film radiograph of a 2-year-old girl following blunt periocular trauma. Although a left orbital wall fracture is not evident, a loculated pocket of intraorbital air is highlighted by the arrow.
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Note the proptosis induced by the large accumulation of intraorbital emphysema. Also, note the relatively nondisplaced nature of the medial orbital wall fracture. This patient experienced a threatened central retinal artery obstruction due to this condition. Evacuation of the orbital air relieved the compromised retinal circulation.
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Fundus photograph of a 24-year-old man with vision loss following blunt periocular trauma. The incident occurred during a baseball game when the patient (a base runner) collided with the catcher. The area of opacification extending from the temporal aspect of the optic nerve head represents retinal ischemia and is indicative of an anterior ischemic optic nerve injury. Such injuries may have a better long-term visual prognosis than posterior ischemic optic neuropathies. Indirect traumatic optic neuropathy more commonly results in posterior optic nerve injuries. Posterior injuries usually do not result in any morphologic change to the optic nerve head appearance.
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Axial CT scan of the orbit. Note the mildly displaced fracture at the junction of the posterior medial orbital wall and optic canal.
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Fundus photograph of the left eye in a 33-year-old male who suffered a severe head injury after falling off a ladder one year prior to presenting to our clinic. The patient has a visual acuity of counting fingers (CF) of 6 feet in his left eye and a large relative afferent pupillary defect. Note the optic nerve's pale appearance.
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