Blindness from optic nerve trauma

RCtheBanditQueen · Nov 19, 2014

My work in progress is a Western; setting - Utah, 1870s. My main character gets blinded in an accident. I have been doing a whole bunch of research, but am still getting it figured out.

I came across some interesting medical journal articles about optic nerve blindness from blunt facial trauma. Supposing that was feasible, what side effects from such an injury (besides the blindness) am I looking at?

The story happens in a frontier town. Being pragmatic here, would the character even survive, due to the lack of advanced medicine and the fact that there's only one person (not a doctor) in the whole town who will help him? Would there be other neurological effects that would make it totally impractical?

(Hoping for no lectures...I'm not the sharpest knife in the drawer, but I really am trying to do this right, I promise. :chair

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King Neptune · Nov 19, 2014

There might be no other effects except blindness. The optic nerve is sensitive, and it can easily be damaged. Even the pressure from glaucoma can lead to optic nerve damage. I haven't looked into optic nerve damage from a punch, but I can imagine it happening from a single punch that wouldn't even cause a black eye, but smashing someone around for a while would make it more likely.

RCtheBanditQueen · Nov 19, 2014

Ooh...so this might really work! :yessmiley

King Neptune · Nov 19, 2014

In addition, I remembered later that people can become temporarily blind from the same cause, pressure of some sort. The blindness can last any amount of time, depending on the location and severity of the damage.

RCtheBanditQueen · Nov 20, 2014

I wonder how long the period of transient blindness could conceivably last. I found a couple different medical reports detailing cases anywhere from a few minutes to several months. I wonder if it could last longer. But then again if it did, the vision that did return would probably be not very good, I would surmise.

BDSEmpire · Nov 20, 2014

Blunt force trauma is horrible stuff. Humans are unbelievably delicate creatures and the awful stuff that can happen when they get whacked with a stick or fall off a horse onto a fencepost will turn your stomach.

On the plus side, humans are pretty dang resilient and have a lot of systems internally for dealing with damage. Medical attention gives you the best chance for recovery but people have been surviving ghastly injuries for as long as there have been people.

Your cowboy could have taken a blow to the bone surrounding the eye and survived. It wouldn't be implausible for there to be swelling that basically kills off the optic nerve in that eye, not to mention basic mechanical damage that wrecks things. They would be in bad shape for quite a while but could eventually get up from an injury like that and get back to living. This assumes they fight off any infection that results from the injury, which happens quite a bit.

They'd be blind in that eye and depending on how much damage there was to the eyeball itself they may lose it completely. The socket will scar over and look gross so an eye patch is in their future. A concussion is also going to come with this kind of injury. Getting your head rattled around hard enough to mangle an eye socket isn't going to do anything good to your brain.

King Neptune · Nov 21, 2014

RCtheBanditQueen said:
I wonder how long the period of transient blindness could conceivably last. I found a couple different medical reports detailing cases anywhere from a few minutes to several months. I wonder if it could last longer. But then again if it did, the vision that did return would probably be not very good, I would surmise.

I am not an expert in the matter, but I have looked into it a little, and the period for eventual recovery could be several years. Since we're talking about optic nerve damage, there might be a partial visual field that would be regained; and, if it did recover, then it is reasonable to think that vision would continue to improve.

I met a guy who had peripheral vision only as a result of optic nerve deterioration resulting from pressure on the nerve. He said that he could see fuzzy shapes in the central visual field, but around the edges of the visual field things were quite clear.

MDSchafer · Nov 21, 2014

I work with people who have had serious physical trauma. I can tell you that what you're saying is rare, but it can and does happen.

I found you a short, and pretty approachable, case study.

http://www.hindawi.com/journals/crira/2013/235209/

RCtheBanditQueen · Nov 21, 2014

Oh boy!! Thanks, guys! This is awesome, getting such tips from people who know more than I do.

BDSEmpire, that is the one thing that I was unsure about - what the chances would be of escaping or fighting off an infection like that in a setting with grossly inadequate medical assistance.

I guess anything can happen in a made up story, but I do want to be realistic.

KingNeptune, that is fascinating. Would you happen to be able to steer me in the direction you have looked into it?

MDSchafer, thank you thank you!! I love case studies.

This is great.

tiddlywinks · Nov 21, 2014

RC, you might want to look into retinal detachment as part of your research. Depending on your character's age and how the blow occurs, this would feasibly cause blindness (given the lack of ability to treat such an injury in the time period you are writing about).

RCtheBanditQueen · Nov 22, 2014

Ah! Thanks, Tiddlywinks! I shall do so. Always in the market for more research.

King Neptune · Nov 22, 2014

RCtheBanditQueen said:
I guess anything can happen in a made up story, but I do want to be realistic.

KingNeptune, that is fascinating. Would you happen to be able to steer me in the direction you have looked into it?

I would be glad to, if I could remember, but it was just material I read when I was looking into macular degeneration, glaucoma, and related problems. Most would have been case studies that were very variable. So you can make up almost anything and it will be believable.

RCtheBanditQueen · Nov 22, 2014

It's all good! I am extremely grateful for your help and tips!! So much to ponder.

Pyekett · Nov 22, 2014

RC, another case study: Man vs. deer
http://webeye.ophth.uiowa.edu/eyeforum/cases/183-traumatic-optic-neuropathy.htm

"Traumatic optic neuropathy" is the technical term for damage to the optic nerve as a result of trauma. There isn't good research to show that any treatment is much more effective in the longterm than just observation for many patients, so many eye centers do a watch-and-wait approach.

Your character could have significant trauma and fractures without anything breaking the skin. If the skin barrier isn't broken, there is much less chance of infection. Survival with blindness that might or might not improve in one or both eyes would be quite plausible, even without any assistance from anyone else at all.

Do you need more information?

King Neptune · Nov 22, 2014

RCtheBanditQueen said:
It's all good! I am extremely grateful for your help and tips!! So much to ponder.

And the more you look into it, the more you'll want to take care of your eyes.

The suggestion about detached retina is very good, because that is not uncommon from blunt force.

RCtheBanditQueen · Nov 23, 2014

Pyekett said:
RC, another case study: Man vs. deer
http://webeye.ophth.uiowa.edu/eyeforum/cases/183-traumatic-optic-neuropathy.htm

"Traumatic optic neuropathy" is the technical term for damage to the optic nerve as a result of trauma. There isn't good research to show that any treatment is much more effective in the longterm than just observation for many patients, so many eye centers do a watch-and-wait approach.

Your character could have significant trauma and fractures without anything breaking the skin. If the skin barrier isn't broken, there is much less chance of infection. Survival with blindness that might or might not improve in one or both eyes would be quite plausible, even without any assistance from anyone else at all.

Do you need more information?

Oooh boy! Thank you for the case study! Deer sure can be dangerous...

I would absolutely gobble up any more info you have or can steer me toward relating to traumatic optic neuropathy, or recovery, or...anything similar!

King Neptune said:
And the more you look into it, the more you'll want to take care of your eyes.

The suggestion about detached retina is very good, because that is not uncommon from blunt force.

Absolutely I do. O.O Yikes. The case studies and whatnot are quite astounding.

kkwalker · Nov 25, 2014

One thing to bear in mind is that damage to the optic nerve or detachment of the retina usually evolves from pretty heavy blunt force trauma--like the face-crushing kind. Or a really lucky (for the attacker) blow. Another place you could take a blow and get blinded from is the back of the head. That's where the visual cortex lies--a part of the brain responsible for translating the optic nerve input. The visual cortex lies just above the cerebellum, the part of the brain that deals with balance and physical orientation. Essentially, a hit to the visual cortex could cause localized brain swelling and either transitory or permanent blindness.

RCtheBanditQueen · Nov 25, 2014

kkwalker said:
One thing to bear in mind is that damage to the optic nerve or detachment of the retina usually evolves from pretty heavy blunt force trauma--like the face-crushing kind. Or a really lucky (for the attacker) blow. Another place you could take a blow and get blinded from is the back of the head. That's where the visual cortex lies--a part of the brain responsible for translating the optic nerve input. The visual cortex lies just above the cerebellum, the part of the brain that deals with balance and physical orientation. Essentially, a hit to the visual cortex could cause localized brain swelling and either transitory or permanent blindness.

That's one thing I was worried about - I didn't want to totally destroy my character's whole face.

If a lucky blow is possible that hits just the right spot without bashing the entire face in, is it just lucky, or one in a million years lucky? I.e., too lucky to use in a story?

I should go do some more research on the visual cortex idea. There are certain ways I reeeeeally want the scene to play out, but I will change those if they can't be done realistically.

tiddlywinks · Nov 25, 2014

kkwalker said:
One thing to bear in mind is that damage to the optic nerve or detachment of the retina usually evolves from pretty heavy blunt force trauma--like the face-crushing kind. Or a really lucky (for the attacker) blow. Another place you could take a blow and get blinded from is the back of the head. That's where the visual cortex lies--a part of the brain responsible for translating the optic nerve input. The visual cortex lies just above the cerebellum, the part of the brain that deals with balance and physical orientation. Essentially, a hit to the visual cortex could cause localized brain swelling and either transitory or permanent blindness.

Depends on how bad your vision is, your age and other such risk factors with the detached retina. If you have 20/20 vision, yes it's less likely to occur from anything that isn't a severe blow, but if you're one of those peeps with bad vision, a natural tiny hole in your retina, or other eye health issue (compound with age), well...

Of course, this could be the horror story optometrists like to tell patients who fit into these risk categories, but I know several folks who have had retinal detachments that were thankfully caught in time and it wasn't from face crushing injuries. Keep in mind they both had less than perfect vision to begin with.

Worth digging into. Either way, sounds intriguing RC.

RCtheBanditQueen · Nov 28, 2014

Definitely fascinating and I am learning a bunch of cool stuff. A bit disturbing too, when you think about what we writers get away with "doing" to our imaginary characters...

kkwalker · Dec 1, 2014

The optic nerve is pretty well protected inside a bone channel in the skull. Causing trauma to that nerve is really unlikely without also causing damage to the surrounding bone--ie crushing the face. At least, that's what my profs told me. Same thing for retinal detachment. You're much more likely to get a retinal detachment from hypertension or diabetes than from trauma. I'm not saying it's impossible, just not as common as a lot of people think. Also, nerve damage is difficult to repair. Nerves don't regenerate well as a rule, although sometimes you get lucky and develop alternate pathways. The head blow thing with trauma to the visual cortex, however, can cause blindness as the brain swells, and then the blindness recedes as the swelling decreases. Sometimes it's still permanent, but it's more likely to cause reversible blindness without massive facial damage.

If you're really stuck on the detached retina or optic nerve damage, you could just have it be a one-in-a-million freak thing. The other thing to remember is, in 1870 it's not like they have MRIs to be able to have a real firm grasp on exactly why your MC went blind. They'll just know he got hit on the head and now can't see.

RCtheBanditQueen · Dec 1, 2014

Thanks kkwalker!

kkwalker said:
If you're really stuck on the detached retina or optic nerve damage, you could just have it be a one-in-a-million freak thing. The other thing to remember is, in 1870 it's not like they have MRIs to be able to have a real firm grasp on exactly why your MC went blind. They'll just know he got hit on the head and now can't see.

That is where I am dithering. I am leaning that way, and for the purposes of the story, I don't need a staggeringly precise amount of detail about how it happens, but I do want it to be believable in case of readers who might know stuff... Lol. Decisions, decisions.

Blindness from optic nerve trauma

RCtheBanditQueen

King Neptune

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