DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.008

Pages: 898-902

Complete optic nerve transection is an exceptional neuro-ophthalmic emergency that results in irreversible blindness. We report the case of a 71-year-old man presenting with bilateral no light perception after a self-inflicted ballistic cranio-orbital injury caused by a handgun. The projectile followed a transcranial trajectory extending from the right temple to the left temple. The patient was discovered approximately 24 hours after the suicide attempt and was brought to the emergency department. Cerebro-orbital computed tomography demonstrated bilateral pre-chiasmatic optic nerve transection associated with orbital fractures and intraorbital foreign bodies. Bilateral ophthalmic surgical exploration revealed no scleral wound. Subsequent left-eye B-scan ultrasonography showed total retinal detachment with vitreous hemorrhage, whereas day-1 fundus examination of the right eye disclosed a flat retina with a small inferior vitreous hemorrhage. Management was multidisciplinary and involved intensive care, neurosurgery, ENT, maxillofacial surgery, psychiatry, and ophthalmology teams. This case highlights the devastating visual consequences of penetrating cranio-orbital trauma and the importance of rapid imaging, multidisciplinary care, and psychiatric evaluation in self-inflicted injuries.