Choroidal rupture following a firecracker injury: OCT findin
The following case has been reported in the Journal of Clinical Ophthalmology and Research.

A 15-year-old boy came with firecracker injury to his right eye. He complained of painful sudden decrease of vision in his right eye since the trauma. The child was brought to our OPD 8 h postinjury. On examination, he was severely photophobic. His best-corrected visual acuity was counting fingers close to face in the right eye and 6/6 in the left eye (Snellen's chart).

Slit-lamp examination of the right eye revealed circumcorneal congestion and epithelial defect involving 90% of cornea. Residues from the firecracker were seen in the fornices. There was no limbal ischemia and intraocular pressure (IOP) was normal digitally.

Clotted blood was seen in the anterior chamber. Pupil was mid-dilated and showed relative afferent pupillary defect (RAPD). Rest of the details was not appreciable. Ultrasound B-scan failed to reveal any posterior segment abnormality. The left eye was essentially normal.

The eye was cleaned. He was started on oral Vitamin C tablets and topically on hourly 1% prednisolone eye drops (Pred Forte, Allergan, Inc. Irvine, CA, USA) and 2% hypromellose eye ointment and 2% homatropine (Homide, Indoco Remedies Ltd.) three times a day.

On first follow-up after 3 days, the epithelial defect had completely healed. The anterior segment was quiet and of normal depth. Pupil was mid-dilated and not reacting to light and pupillary reaction still showed RAPD. Lens was clear. Fundus showed small settled vitreous hemorrhage inferiorly. The disc and retinal vessels were normal.

There were two lesions temporal to the disc: first one midway between disc and macula and the second one around 1 disc diameter from the fovea, at the level of choroid, suggestive of choroidal rupture [Figure 1]. IOP was 12 mmHg with Perkins. The steroids were tapered, and 0.09% bromfenac eye drop was added three times a day and the patient was asked to follow-up after a week.

On review, the cornea showed early stromal scarring, normal limbal architecture, mid-dilated nonreactive pupil with RAPD, and clear lens. The vitreous hemorrhage had cleared and the choroidal ruptures were more clearly seen. Folds in the internal limiting membrane were noted at the macula. Spectral-domain OCT showed the break at the level of retinal pigment epithelium-choriocapillary level suggested choroidal rupture ([after correlating with the fundus picture].

IOP was 28 mmHg with Perkins; steroids were withheld and continued only on bromfenac eye drops three times a day (TDS) and 0.5% carboxymethylcellulose eye drops six times a day. Gonioscopy, done at 1 month, did not reveal any significant abnormality. There was no evidence of choroidal neovascularization or retinal bleed after 1 month of follow-up.

Read more here: https://pxmd.co/jXB2Z
Like
Comment
Share