Contusive injury resulting in confluent areas of opacified, whitened retina.
Blunt ocular trauma annually affects approximately 4.9 per 1,000 individuals.
• Sports-related injury tends to affect younger male patients
• May affect individuals performing household projects or work-related activity
Activities that carry potential for eye trauma such as high impact or contact sports.
• 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
Disruption of outer retina with shearing of photoreceptors due to coup and countercoup forces.
Blunt ocular trauma.
COMMONLY ASSOCIATED CONDITIONS
• Subconjunctival hemorrhage
• Eyelid ecchymosis
• Traumatic iritis
• Angle recession
• Orbital fracture
• Choroidal rupture
• Traumatic macular hole
• 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
Blunt ocular trauma.
• Complete ophthalmic examination
– Dilated fundus examination with scleral depression
DIAGNOSTIC TESTS & INTERPRETATION
• 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.
Photoreceptor outer segments demonstrate shearing injury or fragmentation on electron microscopy.
• White without pressure
• Shallow retinal detachment
• Branch/central retinal artery occlusion
Observation. Condition usually resolves without intervention.
Ophthalmologist evaluation in 1–2 weeks.
Patients instructed to call immediately with signs/symptoms of retinal tear and/or retinal detachment.
Favorable. Usually resolves without sequela.
• Retinal tear and/or detachment
• Possible permanent visual loss
• Macular hole development
• 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.
921.3 Contusion of eyeball
• Whitened retina due to blunt trauma
• Resolves without treatment
• May be associated with visual loss