The patient was a 33-year-old woman who had a sudden loss of vision in the right eye 9 days previously. Her visual acuity was 20/70 OD and 20/20 OS. Her eye pressures were normal. Her ophthalmic examination was remarkable for the fundus findings pictured below. What was the most likely diagnosis? What treatment, if any, would you recommend?
This patient suffered a choroidal rupture from blunt trauma to the right eye from a football. There was a subretinal hemorrhage that was noticeable on fundus photography and OCT, and there was also a small central subfoveal sub-RPE hemorrhage found on examination and OCT. Outside the arcades there were arcuate RPE disturbances, evidently from contusion retinopathy. It is possible that there were associated choroidal ruptures at those locations. Peripherally, there was white without pressure in each eye, and there were no retinal breaks. Given that the subretinal hemorrhage was quite thin and given its duration, the risks of attempted pneumatic displacement of the blood likely outweighed the benefits. This patient was at significant risk for retinal tears, and close observation was planned. She will have an increased lifetime risk of developing a choroidal neovascular membrane in the right eye.
Choroidal ruptures occur when blunt eye trauma deforms the globe, leading to a splitting of the inner choroid in the posterior pole. Subretinal hemorrhaging is common, and there can be associated with contusion necrosis. The ruptures are curvilinear with tapered ends concentric to the optic disc. The visual acuity can be good if the fovea is spared. Patients with angioid streaks can suffer choroidal ruptures from minor eye trauma.
This patient suffered a choroidal rupture from blunt trauma to the right eye from a football. There was a subretinal hemorrhage that was noticeable on fundus photography and OCT, and there was also a small central subfoveal sub-RPE hemorrhage found on examination and OCT. Outside the arcades there were arcuate RPE disturbances, evidently from contusion retinopathy. It is possible that there were associated choroidal ruptures at those locations. Peripherally, there was white without pressure in each eye, and there were no retinal breaks. Given that the subretinal hemorrhage was quite thin and given its duration, the risks of attempted pneumatic displacement of the blood likely outweighed the benefits. This patient was at significant risk for retinal tears, and close observation was planned. She will have an increased lifetime risk of developing a choroidal neovascular membrane in the right eye.
Choroidal ruptures occur when blunt eye trauma deforms the globe, leading to a splitting of the inner choroid in the posterior pole. Subretinal hemorrhaging is common, and there can be associated with contusion necrosis. The ruptures are curvilinear with tapered ends concentric to the optic disc. The visual acuity can be good if the fovea is spared. Patients with angioid streaks can suffer choroidal ruptures from minor eye trauma.
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