BASICS

DESCRIPTION

Contusive injury resulting in confluent areas of opacified, whitened retina.

EPIDEMIOLOGY

Incidence

Blunt ocular trauma annually affects approximately 4.9 per 1,000 individuals.

Prevalence

• Sports-related injury tends to affect younger male patients

• May affect individuals performing household projects or work-related activity

RISK FACTORS

Activities that carry potential for eye trauma such as high impact or contact sports.

GENERAL PREVENTION

• Use of protective eyewear that meets American National Standards Institute (ANSI) Z87.1 safety standard for work-related activities

• Use of protective sport specific eyewear that meet American Society for Testing and Materials (ASTM) standards

PATHOPHYSIOLOGY

Disruption of outer retina with shearing of photoreceptors due to coup and countercoup forces.

ETIOLOGY

Blunt ocular trauma.

COMMONLY ASSOCIATED CONDITIONS

• Subconjunctival hemorrhage

• Eyelid ecchymosis

• Hyphema

• Traumatic iritis

• Angle recession

• Orbital fracture

• Choroidal rupture

• Traumatic macular hole

DIAGNOSIS

• Ophthalmic features of commotion retinae include:

– Opacified, whitish minimally edematous retina

– Undisturbed retinal vessels

– Sometimes associated with sparse retinal hemorrhages or pre-retinal bleeding

– Variable visual acuity (20/20 – 20/400) depending on affected area

HISTORY

Blunt ocular trauma.

PHYSICAL EXAM

• Complete ophthalmic examination

– Dilated fundus examination with scleral depression

DIAGNOSTIC TESTS & INTERPRETATION

Diagnostic Procedures/Other

• Color fundus photography

• Optical coherence tomogram (OCT) may demonstrate hyper-reflective lesion representing disruption at level of photoreceptors and retinal pigment epithelium if affecting macula.

Pathological Findings

Photoreceptor outer segments demonstrate shearing injury or fragmentation on electron microscopy.

DIFFERENTIAL DIAGNOSIS

• White without pressure

• Shallow retinal detachment

• Branch/central retinal artery occlusion

TREATMENT

ADDITIONAL TREATMENT

General Measures

Observation. Condition usually resolves without intervention.

SURGERY/OTHER PROCEDURES

Not indicated.

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Ophthalmologist evaluation in 1–2 weeks.

PATIENT EDUCATION

Patients instructed to call immediately with signs/symptoms of retinal tear and/or retinal detachment.

PROGNOSIS

Favorable. Usually resolves without sequela.

COMPLICATIONS

• Retinal tear and/or detachment

• Possible permanent visual loss

• Macular hole development

ADDITIONAL READING

• Meyer CH, Rodrigues EB, Mennel S. Acute commotio retinae determined by cross-sectional optical coherence tomography. Eur J Ophthalmol 2003;13(9–10):816–818.

• Gass JD. Stereoscopic Atlas of Macular Diseases Diagnosis and Treatment1997:739–741.

• Sony P, Venkatesh P, Gadaginamath S, et al. Optical coherence tomography findings in commotio retina. Clin Experiment Ophthalmol 2006;34(6):621–623.

CODES

ICD9

921.3 Contusion of eyeball

CLINICAL PEARLS

• Whitened retina due to blunt trauma

• Resolves without treatment

• May be associated with visual loss

Stay updated, free articles. Join our Telegram channel

Join