Blunt Trauma Without Break in Eye Wall

In blunt trauma, the object does not penetrate the eye but may cause rupture of the eye-wall. Serious sequelae from blunt trauma affecting the anterior segment include

• angle recession (see also BCSC Section 10, Glaucoma)

• iridodialysis (see also BCSC Section 8, External Disease and Cornea)

• iritis (see also BCSC Section 9, Uveitis and Ocular Inflammation)

• hemorrhage into the anterior chamber (hyphema)

• subluxated or dislocated lens (see also BCSC Section 11, Lens and Cataract)

Serious sequelae from blunt trauma affecting the posterior segment include

• commotio retinae

• choroidal rupture

• macular hole

• choroidal hemorrhage

• retinal tears or detachment

• vitreous hemorrhage

• traumatic chorioretinal disruption (retinal sclopetaria)

See Chapter 16 for discussion of traumatic retinal breaks and retinal detachment and Chapter 20 for discussion of choroidal hemorrhage. Sequelae of the posterior segment are discussed in the following sections.

Commotio Retinae

The term commotio retinae refers to damage to the outer retinal layers caused by shock waves that traverse the eye from the site of impact following blunt trauma. Ophthalmoscopic examination reveals a sheenlike retinal whitening that appears some hours after the injury (Fig 18-1). This retinal whitening occurs most commonly in the posterior pole but may also be found peripherally. Spectral-domain optical coherence tomography (SD-OCT) findings suggest that the major site of disruption is in the photoreceptor and retinal pigment epithelium (RPE) layers, resulting in the observed retinal opacification. With foveal involvement, a cherry-red spot may appear because the cells involved in the whitening are not present in the foveola. Commotio retinae in the posterior pole may decrease visual acuity to as low as 20/200. Gradual visual recovery may occur if there is no associated macular pigment epitheliopathy, choroidal rupture, or macular hole formation.

Figure 18-1 Color fundus photograph reveals commotio retinae (arrows) and vitreous hemorrhage after blunt trauma.

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.