English

Abstract

Central retinal artery occlusion following blunt trauma a 19-year-old patient presented with complaints of severe loss of vision in the right eye following a high pressure compressor gas injury of 1 day duration. External ocular examination revealed ecchymosis in the right eye and relative afferent pupillary defect. Fundus examination showed whiteout retina and a cherry red spot at the macula in the right. A clinical diagnosis of right central retinal arterial obstruction (CRAO) was made. CRAO in young is a rare disease usually found in patients with cardiac embolic diseases, coagulopathies or systemic vascular inflammations and rarely following trauma. Despite active intervention the visual loss persisted. Hence the case report. INTRODUCTION: A 19 year old male presented with history of trauma to the right eye at his work place with a high pressure gas compressor at his work place of 1 day duration. He complained of sudden loss of vision in the right eye. He also complained of redness, watering and pain on eye movements. He did not complain of flashes of light or floaters in the affected eye. There was no history of headache, vomiting, loss of consciousness or nasal bleed. On examination the visual acuity in the right eye was perception of light. Projection of rays was absent in the superior and inferior quadrants and visual acuity in the left eye was 6/6. Examination of the right eye showed ecchymosis in the lids, sub conjunctival hemorrhage, congestion. (Fig. 1) There was a conjunctival laceration from 9-1 clock hours (Fig. 2) with a relative afferent pupillary defect (Grade 3). Fundus examination of the right eye – Media was clear. Disc appeared hyperemic; margins were well defined with a flame shaped hemorrhage at the disc. There was arteriolar attenuation and venous dilatation. Pale whitish edematous retinal area noted in all quadrants with significant edema concentrated over posterior pole. Small area of normal retina noted in nasal and temporal aspect of disc. Vascularity around the macula was obscured and a cherry red spot was seen at the macula (Fig. 3). The intraocular pressure by applanation tonometry was 24mmHg in the right eye and 14 nn Hg in the left eye. The examination of the anterior and posterior segments of the left eye was within normal limits. A diagnosis of traumatic central retinal occlusion was made. Routine blood investigations and coagulation profile was done which was normal. CT orbit showed extensive areas of air pockets in extraconal and intraconal area along with extension into the optic canal and suprasellar areas. (Fig. 4) (Fig. 5). Treatment was initiated with ocular massaging, paracentesis, vasodilators-nitrates, topical antibiotic-NSAID combination, topical timolol malleate BD and oral acetazolamide 500mg BD. Oral steroids were started 1mg/Kg per body weight. Vision improved to hand movements on the first day after treatment. 4 weeks later the vision improved to counting fingers close to face and 4/60 in the temporal quadrant. Rapd remained in the right eye, the fundus showed a paler disc with retinal whitening and a cherry red spot at the macula. DOI: 10.14260/jemds/2014/3954