Posterior pole retinal tears following blunt ocular trauma
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
Blunt ocular trauma is a significant source of ocular morbidity worldwide.Posterior pole retinal tears occur rarely following blunt trauma. Here present the unusual case of post-traumatic macular tearing due to blunt trauma. This case report postulates the pathogenesis of macular tears following blunt ocular injury, and underscores the importance of close follow-up of blunt trauma with appropriate imaging.

A 17-year-old patient presented to our emergency unit with blunt ocular trauma and multiple maxillofacial fractures after being assaulted. On examination visual acuity was 20/200 in the left eye with scant vitreous and preretinal hemorrhages. Funduscopic examination revealed multiple choroidal ruptures running concentrically to the optic disc, a subretinal macular hemorrhage, and a large macular tear in the area of the inferior vascular arcade just temporal to the macula. Optical coherence tomography revealed subretinal fluid in the foveal area, choroidal ruptures and a slight elevation of the macular retinal tear margins without subretinal fluid.

Laser retinopexy was performed around the macular tear nasally. On follow-up, the retina in the lasered area remained flat, while a shallow retinal detachment had developed temporal to the tear, with a second tear appearing superotemporally to the macula. Laser retinopexy was not possible due to surrounding subretinal hemorrhage. The clinical course was later complicated by macular detachment, necessitating pars plana vitrectomy with endolaser around the posterior tears and the retinal periphery, and silicone oil injection.

Conclusively, traumatic macular holes and traumatic macular choroidal ruptures have both been extensively described, posterior pole and macular retinal tears following blunt trauma have rarely been reported. This case illustrates this unusual finding, discussing the possible pathogenic mechanisms and the importance of close follow-up of patients after blunt trauma with appropriate imaging.