Chandigarh doctor reports rare case of retinal haemorrhage from blunt eye injury
Dr Jitender Jinagal and colleagues at Government Medical College and Hospital, Chandigarh, India have reported a rare case of Retinal haemorrhage from blunt Ocular Trauma. The case has appeared in the New England Journal of Medicine.
Generally encountered during adolescence, blunt ocular trauma results in a variety of changes in the fundus. Trauma-induced retinal haemorrhages are rare, but if a patient comes in with one be sure to conduct a comprehensive examination. Experts agree that possible damage to the globe and retina have more serious repercussions than the haemorrhage itself. Many different types of ocular trauma can cause retinal haemorrhage among them are Valsalva’s retinopathy, choroidal rupture and commotion retinae, which results from serious blunt trauma.
A 24-year-old man presented to the emergency department with pain, swelling, and decreased vision in his right eye 6 hours after it had been directly struck by a tennis ball. Physical examination of the right eye showed visual acuity of 20/400, with an intraocular pressure of 20 mm Hg (reference range, 10 to 21) and a sluggish pupillary response to light. The left eye appeared normal, with a visual acuity of 20/20 and an intraocular pressure of 18 mm Hg. Slit-lamp examination of the right eye showed oedema of the eyelid, conjunctival congestion, and a normal anterior chamber, cornea, and lens.
On examination of the fundus, however, the foveal reflex was absent owing to the presence of a retinal haemorrhage at the macula (arrowhead) that measured approximately 5 disk diameters. A D-shaped subhyaloid hemorrhage (arrow) was also seen below the fovea and above the inferior arcade. A pars plana vitrectomy with internal tamponade was performed. At the 8-week follow-up visit, the patient’s visual acuity in the right eye had improved to 20/30, and examination of the fundus showed resolution of the retinal haemorrhage and a normal foveal reflex.
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