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This report describes the only case in the literature of globe luxation due to traumatic cerebrospinal fluid fistula to the orbit caused by fire gun with ocular globe maintenance. E.N., female, white, 7 months, admitted with left orbitocranial injury by fire gun. Ocular globe luxation was detected with complete ocular motility restriction and absence of pupillary reflex in the left orbit. Computed tomography showed fracture of the medial orbital wall; bone fragments near the apex of the orbit and a stretched optic nerve. Surgical exploration was performed, showing liquor fistula through the ethmoid-sphenoid wall that was blocked with sponge (Gelfoam®) plus organic glue in the left orbit posterior wall, with immediate resolution of the proptosis and ocular integrity maintenance. Although controversial, maintenance of the ocular globe instead of enucleation was performed due to the integrity of the globe in this case. Despite the blindness, we considered the result to the proposed treatment excellent, once the maintenance of the ocular globe provides a good appearance and will contribute to an adequate facial bone development.

Traumatic optic nerve avulsion is a rare event. A case of complete unilateral optic nerve avulsion after blunt ocular trauma without major damage to other ocular structures is reported. B-scan ultrasonography with 10 and 20 MHz probes proved to be helpful in diagnosing the optic nerve lesion, whereas orbital computed tomography was inconclusive. The prognosis is ominous and it is dependent on the initial visual acuity, which was no light perception in this case. There is no efficient treatment for complete optic nerve avulsion, and no specific treatment was performed in this case.

Optic nerve avulsion is a rare, but devastating complication. In this condition, the optic nerve is forcibly disinserted from the retina, choroid, and vitreous, and the lamina cribrosa is retracted from the scleral rim. If the media are clear, the avulsion is easily diagnosed. The appearance of the fundus is striking, with a hole or cavity where the optic disc has retracted into its dural sheath. The complementary examinations are not very accurate for the diagnosis of this pathology and with some residual vision, opaque media, that occur in partial avulsion, the diagnosis may be mistaken or delayed. In this article we report a case of complete optic nerve avulsion examined at the Retina and Vitreous Department of the "Hospital das Clínicas" of the Federal University of Uberlândia - MG - Brazil.

Traumatic optic nerve avulsion occurs most commonly after blunt ocular trauma. Optic nerve avulsion by high caliber bullet is exceptional and must be thought of in the management of those patients victims of gunshot wounds to the globe and orbit. The present paper reports the first documented case of this singular condition of optic nerve injury and comments on several other related causes, pathophysiology mechanisms, histology and management.