Rupture of the choroid after eyeball contusion--an analysis based on the Erlangen Ocular Contusion Registry (EOCR)

Abstract

Ocular injuries may lead to severe damage of the posterior segment with manifest visual impairment. Choroidal ruptures are frequently masked by acute subretinal haemorrhage. We analysed possible predictive factors and functional results of eyeballs with rupture of the choroid after ocular contusion. We performed a retrospective study of 376 consecutive inpatients (Erlangen Ocular Contusion Registry - EOCR, over a 10-year period), who were treated because of a blunt eye injury at our eye hospital (86 % males). Detailed notes regarding the anterior and posterior segments were extracted from the standardised charts. Mean age was 28.8 +/- 16.1 years (4 to 84 years). Eyes with previous trauma or globe ruptures were excluded. Twenty-six of 376 patients developed choroidal rupture due to ocular contusion (6.9 %). A choroidal rupture was more frequent in females (9.4 %) than in males (6.5 %). Patients with choroidal rupture were treated as inpatients 5 days longer than patients without (10.7 vs. 5.5 days; p < 0.001). Twenty-two percent of the injuries occurred during work time. Main causes of choroidal ruptures were water jet (19 %), fireworks (12 %), elastic cords (12 %), metal pieces (12 %), gotcha (8 %) and champagne corks (8 %). The risk for developing a choroidal rupture due to water jet or fireworks injuries was increased 9 or 4 times. Ninety-two percent of choroidal ruptures were located at the posterior pole and concentric, 40 % were submacular, 12 % outside the large temporal vessels (4 % were located both centrally and peripherally). Initial visual acuity (VA) and VA at discharge were decreased significantly in eyes with rupture of the choroid (20/200 and 20/60) in contrast to eyes without (20/40 and 20/25; p < 0.001). Choroidal ruptures were often associated with iridodialysis, lens dislocation and contusion cataract (3 x ), vitreous haemorrhage (4 x ), complete retinal defects (6 x ), ciliary body clefts (7 x ) or hyphema rebleeding (4 x ). No association between the height of hyphema and choroidal ruptures was found. The predictive level of choroidal ruptures was 40 % in eyes with a combination of lens dislocation, traumatic cataract and vitreous bleeding. The final VA was 20/200 or less in 11 eyes associated with a prevalence of 55 % of ruptures submacularly. In contrast to this, eyes with VA > 20/200 developed 26 % submacular choroidal ruptures. Additional severe traumatic changes of the anterior and posterior segment were found 2 - 7 times more frequently in eyes with choroidal ruptures compared to eyes without those ruptures. The visual improvement was limited due to submacular ruptures. Frequent ophthalmological controls are recommended to minimise the risk of choroidal neovascularisation in a submacular location.