Common Symptoms
A history of orbital bullet injury with associated signs and symptoms of orbital trauma. Visual acuity is variably affected based on the presence of associated trauma including maculopathy and/or neurologic injury. Visual field defect is present in areas of chorioretinal rupture. Pathology may be identified incidentally during routine examination in patients with a history of remote trauma.
78.1.2 Exam Findings
Acute exam often has extensive patch of choroidal and retinal hemorrhages. Late examination shows full-thickness chorioretinal defect with white fibrous proliferation and surrounding pigmentary changes (▶ Fig. 78.1). Rare association with early retinal detachment.
Fig. 78.1 Color fundus photo of the left eye with remote history of orbital missile injury demonstrating an area of macular fibrosis along inferior arcade with pigment superiorly consistent with chorioretinitis sclopetaria.
78.2 Key Diagnostic Tests and Findings
78.2.1 Optical Coherence Tomography
Optical coherence tomography demonstrates full-thickness hyperreflectivity and disorganization consistent with chorioretinal disruption and subsequent reparative gliotic proliferation.
Fig. 78.2 (a) Early fluorescein angiography demonstrating lack of choroidal circulation due to loss of tissue. (b) Late fluorescein angiography demonstrating staining of the sclera and at the lesion’s margins.
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