Traumatic Chorioretinal Disruption (Retinal Sclopetaria)
An unusual retinal pathology can be produced by high-speed projectile injuries to the orbit. Large areas of choroidal and retinal disruption combine with extensive subretinal, retinal, or vitreous hemorrhage. As the blood resorbs, the injured area is repaired by extensive scar formation and widespread pigmentary alteration (Fig 18-5, see also Fig 18-4). If the macula is involved, there is significant loss of vision. Secondary retinal detachment rarely develops. The pattern of damage is ascribed to shock waves generated by the deceleration of the projectile passing close to the sclera. Blunt trauma due to injuries from paintballs or other projectiles may produce a similar fundus appearance.
Figure 18-5 A color fundus photograph from a patient shot with a bullet 2 months earlier in the right inferotemporal orbit, causing the sequelae of retinal sclopetaria. The bullet’s path missed the globe by several millimeters, and the patient acutely lost visual acuity. The image shows large areas of subretinal proliferation and retinal pigment epithelial hyperplasia, consistent with moderate to severe retinal sclopetaria. Visual acuity returned to 20/70.
(Courtesy of Richard F. Spaide, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.