Supplementary Material for: Orbital Fracture Resulting in Contralateral Optic Canal Fracture with Traumatic Optic Neuropathy: A Case Report

A 19-year old male presented with immediate total loss of vision to no light perception in the right eye after being struck on the left cheek by a lawn sign. Computed tomography and magnetic resonance imaging revealed left orbital floor fracture and right optic nerve enhancement. The patient was treated with high-dose intravenous corticosteroids and plasma exchange for a presumed inflammatory or traumatic optic neuropathy. Repeat orbital imaging revealed a right optic canal fracture (OCF) with bony impingement of the optic nerve. The patient underwent endoscopic optic nerve decompression; a 4x5mm bone fragment abutting the optic nerve was removed. 1 month later, vision improved to hand motion. Imaging may fail to detect OCF, and visual prognosis depends on time to surgery and fracture pattern. Therefore, operative management and preoperative intravenous corticosteroids, though controversial, may be considered even in the absence of radiographic findings of bony impingement causing direct traumatic optic neuropathy (TON). Isolated OCF without continuous fractures originating at the injury site is also a rare fracture pattern and potential cause of direct TON.