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Delayed presentation of vision loss secondary to traumatic dissection of the ophthalmic segment of the internal carotid artery: a case report.

Johnson JN; Parrish AJ; Mancho S.
Wright State University Plastic Surgery Residency Program
2019-02-15

Presenter: Jamie Johnson

Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.

Director Name: R. Michael Johnson, MD

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial

Blindness is a rare, but well-documented, complication associated with high energy facial fractures. In systematic literature reviews, injuries causing blindness are most commonly related to open globe trauma and retrobulbar hemorrhage. However, indirect causes of ischemia to the retina or optic nerve can also cause loss of vision and often have a less predictable course. A case report of an otherwise healthy military veteran with delayed presentation of visual loss secondary to traumatic dissection of the ophthalmic segment of the internal carotid artery is presented.

A 41-year-old male presented after unhelmeted motorcycle crash, where he was intubated and sedated prior to arrival. He was found to have significant craniofacial fractures and intracranial bleeding. On initial examination, he had amaurosis bilaterally and traumatic optic neuropathy with poor prognosis for visual recovery of the right eye. After fixation of the patient's right-sided facial fractures, the patient was extubated and right visual loss was confirmed. Vision on left was reported as baseline by the patient. Two weeks later, the patient suffered acute and progressive visual decline in his left eye. Repeat imaging and angiography demonstrated a dissection of the internal carotid ophthalmic segment not initially seen prior vascular studies. The patient underwent emergent endovascular intervention and slowly regained vision in the left eye. This case highlights the need for a high level of suspicion for traumatic vascular and ophthalmologic injuries, even when there is no direct association with facial fracture, and further investigation into whether more specialized imaging should be recommended.

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