Commotio Retinae Research Articles

Intraretinal hyperreflective line: potential biomarker in various retinal disorders.

The intraretinal hyperreflective line (IHL) is a novel posterior segment finding demonstrable using careful optical coherence tomography (OCT) examination. It likely indicates a reaction against photoreceptor, Muller cell, and/or retinal pigment epithelial damage. This study analyzed the spectral-domain OCT characteristics of IHLs to disclose their presence in various retinal conditions. A retrospective review of the charted and imaging records of participants with IHL was conducted at Dokuz Eylul University Department of Ophthalmology between January 2019 and August 2023. The inclusion criterion was the detection of an IHL on good-quality B-scan spectral-domain OCT. An IHL was defined as a vertical line extending from the ellipsoid zone band (or lower) through the outer nuclear layer to the internal limiting membrane in the central fovea. Associated retinal conditions were recorded as potential causative factors for the presence of IHL. IHL was observed on spectral-domain OCT in 40 eyes of 38 participants with several retinal diseases assessment. Fourteen eyes (35%) underwent vitreoretinal surgery pre-IHL detection (12 were operated for full-thickness macular hole [FTMH], one for epiretinal membrane [ERM], and one for rhegmatogenous retinal detachment). In six eyes (15%) a microhole coexisted. Four eyes (10%) had a concurrent lamellar macular hole. The IHL preceded the occurrence of FTMH in three eyes (7.5%), and diabetic macular edema and type 2 idiopathic macular telangiectasia (MacTel-2) were present in three eyes (7.5%) each. The remaining conditions included vitreomacular traction (VMT), nonarteritic anterior ischemic optic neuropathy with central retinal artery occlusion, commotio retinae, exudative age-related macular degeneration, ERM, non-infectious idiopathic posterior uveitis, and Coats' disease, each affecting one eye (2.5%). Of the two participants with bilateral involvement, one was diagnosed with MacTel-2 and the other had IHL with VMT in the right eye that was detected post-vitreoretinal surgery for FTMH in the left eye. Although IHLs are mostly identified in eyes with vitreomacular surface diseases, clinicians may encounter IHLs in other types of retinal pathology. Further large-scale, multicenter, long-term studies on the presence of IHLs in OCT imaging are required to provide more substantial insight on this biomarker.

Utility Assessment of Follow-up Evaluation for Commotio Retinae

Purpose: To perform an outcome-and-cost analysis of follow-up visits and associated imaging in patients presenting to the Massachusetts Eye and Ear (MEE) emergency department with commotio retinae. Methods: This retrospective consecutive case series comprised consecutive patients presenting to the emergency department from January 1, 2020, to January 1, 2022, who were diagnosed with contusion or other injuries of the eye or orbit (International Classification of Diseases, 10th edition, codes S05.1 and S05.8). Cost analysis was performed using Medicare fee data and previously described methods. Costs considered included follow-up examinations, optical coherence tomography (OCT), and fundus photography. Results: Of the 490 patients presenting to the emergency department, 201 had findings of commotio retinae on examination and were included in this study. Of the 201 patients with initial commotio retinae, 142 (70.6%) returned for follow-up. OCT was performed in 34% of patients and fundus photography in 33%. A total of 254 follow-up visits were conducted. Four patients (2.8%) had retinal tears on follow-up, with only 1 (0.7%) developing a retinal detachment. Complications requiring intervention were always heralded by worsening symptoms. The total cost of follow-up was $60,436 for the cohort and $425.60 per patient. Conclusions: Patients with commotio retinae infrequently develop retinal complications and have a high rate of loss to follow-up. Significant resources are dedicated to following up and imaging patients with commotio retinae. Our results underscore the low utility in multiple follow-up visits among asymptomatic patients.

Ocular trauma in badminton: A 5-year review of badminton-related eye injury emergency department presentations.

To examine the nature and severity of badminton-related ocular injuries in Melbourne, Australia. This is a retrospective chart review. A search of the medical records was conducted for patients presenting to the ED at The Royal Victorian Eye and Ear Hospital, with badminton-related eye injuries from June 2018 to May 2023. Data were extracted, focusing on injury mechanism, patient demographics and treatment outcomes. In total, 88 patients were included in the study, comprising 64 (73%) men and 24 (27%) women. The mean patient age was 36.13 years. The most common injury was hyphaema (73%), followed by commotio retinae (45%). One patient sustained a penetrating eye injury when a shuttlecock shattered the spectacles he was wearing during play. Medical intervention was required for 90% of patients. The most common interventions were steroid eye drops (80%) and cycloplegic eyedrops (76%). A total of six (7%) patients required surgical management. For those 69 patients followed up at The Royal Victorian Eye and Ear Hospital, 77% of patients had a final best-corrected visual acuity of 6/6 or greater. Hyphaema, commotio retinae and traumatic uveitis were the most commonly diagnosed injuries. The majority of patients with badminton-related eye injuries required medical treatment, and some necessitated surgical intervention. To mitigate these risks, there is a pressing need to develop an eye safety policy for Australian badminton players, and players should exercise caution when wearing spectacles during play to prevent potential penetrating eye injuries.

Secondary Multiple Evanescent White Dot Syndrome Following Blunt Trauma.

To report a case of secondary unilateral MEWDS following blunt trauma to the eye. Observational case report of one patient. A 25-year-old male initially presented after being hit in the left eye with a football, with visual acuity of 20/50, traumatic iritis, commotio retinae, vitreous hemorrhage, and a large pigment epithelial detachment in the superior macula. He was lost to follow-up for two years before presenting with a sudden decrease in vision. On exam, best corrected VA (BCVA) was counting fingers and clinical exam demonstrated fibrosis in the superior macula, small white lesions around the optic disc and throughout the posterior pole, and ellipsoid zone disruption on OCT. Given the clinical appearance, a diagnosis of Multiple Evanescent White Dot Syndrome was made and the decision was made to observe. Two months later, without treatment, BCVA improved to 20/20, and there was resolution of the white lesions in the posterior pole as well as improved continuity of the ellipsoid zone on OCT. We describe a case of Multiple Evanescent White Dot Syndrome two years after blunt trauma to the eye; a far longer latency than previously reported cases of MEWDS secondary to blunt trauma.

Delayed manifestation of a full-thickness traumatic macular hole: Probable causes and consequences – A case report

A 23-year-old male experienced a cricket ball injury to his right eye 1 day ago. Right eye visual acuity was counting fingers close to face. He presented with anterior uveitis, commotio retinae, and vitreous hemorrhage. Steroids and cycloplegics were given. Fundus showed resolved vitreous hemorrhage, a healthy optic disc, patchy epiretinal membrane, choroidal ruptures, peripapillary scarring, and 20/80 vision on follow-up. Patient developed a full-thickness macular hole 11 months after trauma, decreasing vision to 20/120. Exam and optical coherence tomography showed no abnormal posterior vitreous detachment. Macular hole surgery closed the hole with a normal foveal contour without improving vision. At the last follow-up 6 months after surgery, the hole was closed and vision improved to 20/120. A delayed traumatic macular hole unrelated to vitreomacular traction or cystoid macular edema deroofing has not been reported in literature. Traumatic macular hole development may be delayed by secondary epiretinal membrane contraction, ocular movements, or expansion of choroidal rupture.

Presentations and Incidence of Ocular Injuries Caused by Motorcycle Accidents in Iraq

Background Motorcycle accidents can be particularly hazardous, as riders are exposed to various risk factors, such as high speeds, lack of protective enclosures, and limited safety features. Aim of the study To describe the ocular injuries associated with motorcycled accidents presented to a tertiary center in Iraq. Patients and methods A multicenter cross-sectional (survey) study that involved 335 cases of motorcycle accidents that presented with unilateral or bilateral ocular trauma. The study was carried out at Ibn Al-Haitham Teaching Hospital, Al-Nauman Teaching Hospital, Al-Diwaniyah Teaching Hospital, and forensic centers located in Baghdad (Iraq capital) and Al-Qadisiyah from 1st of June 2019 to 1st of June 2023. Information regarding ocular injuries was recorded and classified according to the International Ocular Trauma Classification. Results The study involved 335 ophthalmological accidents; the mean age of the patients was 27.84± 9.6 years, most of them were males (96.7%), and there were only 11 females as passengers, 39 (11.6%) had injuries in both eyes. Lesions involving the periorbita, lids, and conjunctiva comprised most of the findings. There were 60.9% of patients with lid lacerations with or without sub-conjunctival bleeding, 22.1% with corneoscleral injury, and 17.9% with commotio retinae. It was the leading cause of decreased visual acuity, with 9% having lens capsule damage with or without iris prolapse and 8.1% having a ruptured capsule, 55.82% of patients had a mild injury, 27.16% had a moderate injury, and 17.01% had a severe injury. Conclusion Eye injury associated with motorcycle accidents mainly affect males in their youth age and has serious outcomes, sometimes ending with blindness.

Incidence and Outcomes of Eye Trauma Associated With Recreative Use of Nonpowder Toy Guns: A 12-Year Retrospective Study

Nonpowder toy guns (NPTGs) are responsible for many ocular traumas. This study aims to detail the outcomes of these injuries depending on the causative NPTG. Retrospective, observational case series. Cases of NPTG-associated ocular trauma managed in a Parisian eye emergency department between August 1, 2010, and January 1, 2023, were reviewed. The date of trauma, causative NPTG, patient demographics, initial and follow-up eye examinations, any surgical procedure, and visual outcomes for each ocular trauma were analyzed. Over 12 years, NPTGs were responsible for 324 eye injuries and 980 visits. Patients were mostly male (77.5%), and mean age at trauma was 16.2 years. Foam bullets or foam dart blasters accounted for 54.9% of traumas and were mainly responsible for corneal injuries and hyphema (30.9% and 27%, respectively). BB guns and airsoft guns were frequently responsible for anterior segment lesions, as well as intravitreal hemorrhages (14.7%) and commotio retinae (21.1%). Paintball guns accounted for the largest proportion of posterior segment lesions (eg, intraretinal or subretinal hemorrhages leading to macular atrophy/contusion maculopathy), and one-third of casualties had undergone ocular surgery. Among all traumas, final visual acuity was lower than 20/200 in 6.5% of cases. Phthisis occurred in 8 cases: Two were related to foam bullets or foam dart blaster injuries (1 contusion and 1 rupture), 2 other cases followed a rupture due to BB guns/airsoft guns, 1 case occurred after a rupture related to a paintball gunshot, and 3 others were due to other types of compressed air guns (1 rupture, 1 intraocular foreign body, and 1 total retinal detachment). NPTG-related ocular trauma outcomes differ according to the causative toy. Paintball guns and BB guns/airsoft gun-related traumas were more likely to be associated with severe lesions, but an increasing number of ocular injuries related to the use of foam bullets or foam dart blasters are reported in younger and younger children. Public health policies should promote the use of protective eyewear.

Современный подход к хирургическому лечению травматических субретинальных макулярных кровоизлияний с разрывом хориоидеи (серия наблюдений)

The selection of management strategy for closed globe injury with massive submacular hemorrhage (SMH) remains a pertinent issue, particularly in the context of the advent and improvement of surgical techniques. These patients typically maintain an active lifestyle and are highly demanding with regard to vision. Moreover, existing observational approaches and passive management of SMH are unacceptable for them. This paper describes two patients with closed globe injuries accompanied by SMH and significant vision loss. The active management strategy employed for these patients (pneumodislocation plus enzymatic lysis) was analyzed based on the results of optical coherence tomography, eye fundus photography, and visual acuity measurement. The intravitreal injection of drugs and a gas-air mixture resulted in a significant improvement of visual acuity due to the displacement of the subretinal blood clot to the extramacular area, reduction in the height and area of hemorrhage, and elimination of the toxic effect of blood elements on the retinal pigment epithelium and photoreceptors. This management strategy for SMH helps improve vision in a short time interval and to reduce potential negative effects of this condition. KEYWORDS: subretinal hemorrhage, closed globe injury, choroidal rupture, intravitreal injection, tissue plasminogen activator, commotio retinae. FOR CITATION: Seleznev A.V., Amashova U.L., Brezhnev A.Yu., Nagornova Z.M., Egorova A.C., Kuroyedov A.V. Contemporary approach to the surgical management of traumatic submacular hemorrhage with choroidal rupture (case series). Russian Journal of Clinical Ophthalmology. 2024;24(2):94–100 (in Russ.). DOI: 10.32364/2311-7729-2024-24-2-9.

Chronic Widespread Commotio Retinae Following Open-Globe Injury With Vitreous Incarceration.

Chronic Widespread Commotio Retinae Following Open-Globe Injury With Vitreous Incarceration.

Characterization of Ocular Injuries Caused by Orbeez Hydrated Gel Pellet Projectiles: Clinical Insights and Implications

To examine the clinical characteristics of patients who have experienced blunt ocular injuries from "Orbeez" hydrated gel pellets (Spin Master Corp.), and to describe ocular morbidity, visual acuity (VA), and intraocular pressure (IOP) after Orbeez-related ocular trauma. Retrospective, institutional, observational case series. Patients sustaining Orbeez-related ocular trauma at a single institution over a 13-month period were identified. Clinical parameters including VA, IOP, and anterior and fundus examination findings were assessed upon initial and final presentation. Basic statistical testing was performed to compare differences within this cohort. A total of 17 eyes from 17 patients with Orbeez-related trauma were identified. Orbeez-related blunt ocular injuries included corneal abrasion (n=7), hyphema (n=9), commotio retinae (n=5), intraretinal hemorrhage (n=3), preretinal hemorrhage (n=1), vitreous hemorrhage (n=2), and retinal tear (n=1). Adolescents (14-18 years of age) showed higher rates of posterior segment complications compared to other ages (P=.0152). The presence of elevated IOP and hyphema upon initial examination correlated with increased likelihood of requiring invasive treatment following Orbeez impact (P=.0275). Orbeez-related ocular trauma may be associated with severe visual morbidity and varied anterior and posterior segment intraocular sequelae. Adolescents could be at increased risk for posterior segment complications following these injuries. Initial findings of elevated IOP and hyphema may indicate a need for more aggressive interventions. Prevention remains paramount in managing Orbeez-related ocular trauma; it is critical to raise awareness regarding the importance of wearing eye protection meeting high-impact standards and minimizing exposure to such projectiles.

A Case of Berlin’s Edema after Fire Cracker Injury

A 22 year old medical student presented in ophthalmic out patient department with fire cracker injury. On examination, hisright eye anterior segment was normal, and there was corneal edema with mild congestion in the left eye. Fundus examinationrevealed commotio retinae or Berlin’s edema in left eye. Ultrasonography B scan was normal and OCT revealed Berlin’s edemawith images of specific retinal layers affected by commotio retinae. The case report describes corneal edema and Berlin’s edemain detail. The case report also describes the importance of public awareness regarding the safe handling of firecrackers.

Clinical Audit on Badminton-Related Ocular Injuries in a Tertiary Hospital in Malaysia.

Background Badminton-related ocular injuries are among the commonest causes of blunt trauma to the eye, which can lead to significant damage to the ocular structures. This study aimed to assess the clinical presentations, complications, and visual outcomes of patients who sustained ocular injuries related to badminton treated in a single tertiary center in Malaysia. Materials and methods A retrospective clinical audit was conducted in Hospital Universiti Sains Malaysia (HUSM), Malaysia, involving patients diagnosed with ocular injuries related to badminton, either as players or spectators, between January 1, 2003 and December 31, 2017. The demographic data, mechanism of injury, and clinical presentation were recorded. In addition, visual acuity, anterior and posterior segment, and intraocular pressure (IOP) measurements were recorded at the initial presentation and at the present recruitment period. Management at the initial presentation was also obtained and recorded. The final visual outcome and complications were based on the finding of the most recent follow-up. Visual acuity was categorized as follows: mild or no visual impairment (6/18 or better), moderate and severe visual impairment (<6/18 and worse). Results A total of 23 patients (23 eyes) were included in this clinical audit. The average age was 24 years, with a range of 6-56 years, with the highest incidence occurring at the age of 20 years old and younger. The majority of the injuries were sustained during the single-player game. All the injuries were caused by shuttlecock hits. In 18 cases (78%), the trauma was caused by an opponent, in four cases (17%) by a partner, and in one case involving a bystander. Most of the patients in this series were not using any protective eyewear while playing the game 96% (22). Most injuries (22 eyes) involved the anterior segment, with hyphaema as the commonest clinical presentation. The mean IOP at presentation was 23.5 (11.2) mmHg. Angle recession was detected as early as one-week post initial presentation in 17 eyes. Commotio retinae (5 eyes) and vitreous hemorrhage (4 eyes) were the common posterior segment findings. There were eight eyes with visual acuity of worse than 6/18 at the initial presentation, but only three eyes had poor final visual acuity. There was a statistically significant improvement in visual acuity at the last follow-up compared to the initial presentation (Fisher's exact test) (p=0.032). Conclusion Ocular injuries related to badminton is common and cause a detrimental effect on the long-term visual outcome. Traumatic hyphaema and commotio retinae are the most common presenting signs related to poor visual outcomes. Therefore, protective eyewear and promoting awareness of badminton-related ocular injuries are essential to prevent monocular blindness in young adults.

Traumatic Maculopathies Associated with Closed-Globe Injury

Traumatic maculopathies due to closed-globe injury are commotio retinae (Berlin’s edema), choroidal rupture, traumatic macular hole, retinitis sclopetaria, shaken baby syndrome, Valsalva retinopathy, and Purtscher retinopathy. The main pathology in commotio retinae is in the outer retinal layers and usually resolves spontaneously. Blunt eye traumas coming from the anterior aspect can cause choroidal ruptures. These are mainly due to the rupture of inelastic Bruch membrane and adjacent structures. If they involve fovea, visual loss can occur. Late choroidal neovascularisation may develop in 1/10 of the cases. Traumatic macular holes develop in less than 2% of the blunt ocular traumas. Early macular holes result from tangential traction whereas late holes from anteroposterior vitreoretinal traction. They can be closed spontaneously within 4 months, especially in young patients. Retinitis sclopetaria is rare. It results from high-velocity pellets that hit but do not penetrate the globe. Shock waves can cause the rupture of the choroid and overlie the neurosensory retina. The shaken baby syndrome is a result of the violence in the family. It must be reported to the police. Retinal hemorrhages, cotton wool spots, and hemorrhagic retinoschisis areas are the prominent features. The sudden increase in intrathoracic or abdominal pressure may lead to the rupture of the retinal capillaries and usually a sub-internal limiting membrane hemorrhage in Valsalva retinopathy. If it is larger than 3-disc diameters and persists for more than 3 weeks; it may be drained into vitreous with an Nd-YAG laser. Purtscher retinopathy is an occlusive microvasculopathy resulting from severe head trauma or compression injuries of the thorax. Intraretinal hemorrhages, geometric white areas (Purtscher flecken), and cotton wool spots are typical features. Usually fades within 1-2 months. Medicolegal aspects as well as ocular and systemic associations are also important in closed globe injuries and should not be neglected.

Maculopathies Secondary to Mechanical and Blunt Trauma

Blunt eye trauma includes the mechanical deformation of the globe with foreign bodies or the damage that occurs by the direct penetration of the energy to the tissues. It is estimated that it accounts for more than 2% of 2,5 million eye injuries per year only in the United States. Retinal or macular damage due to blunt injury includes the following well-known conditions such as commotio retinae (Berlin’s Edema), choroidal rupture, retinal tears, retinal detachment, retinal dialyzes, and macular hole. Although the clinical presentations of retinal and choroidal lesions are well defined, the pathogenesis of them is not clear yet. Besides the most accepted theory which supposes that the main cause of the retinal injury is vitreous traction, alternative comments suggest differential globe layer deformation and increased inner limiting membrane rigidity. Today, by the available advanced vitreoretinal surgery technics, the chance of the patient for functional recovery is higher than before. However, the pharmacological methods for preventing/ treating retinal or macular damage are still in their infancy.

Traumas Affecting the Posterior Segment in Pediatric Cases

Effects of childhood eye traumas on the posterior segment; It includes a wide spectrum from preretinal hemorrhage to the clinical presentation that may result in phthisis bulbi. This situation may present with clinical statuses such as commotio retinae, retinal hemorrhages, choroidal rupture, vitreous hemorrhage, lens dislocations, retinal detachment, intraocular foreign body, endophthalmitis, macular hole, and choroidal detachment. In spite of all efforts in the treatment of these patients, satisfactory visual and anatomical results cannot be obtained due to the difficulties in the response to trauma affecting the posterior segment in children and the difficulties in the healing process. In this review; It will be discussed which clinical manifestations in the posterior segment of open and/or blunt eye traumas in childhood may occur, as well as which approaches can be applied during the evaluation and treatment of patients.

Selective rod outer segment disruption in commotio retinae - a finding identified on Multicolour® Imaging.

To report Multicolour® imaging (MCI) findings in commotio retinae (CR) involving macula and correlate topographically with outer retinal layers on optical coherence tomography (OCT). This retrospective study included participants with CR involving macula without any other type of traumatic maculopathy and imaged with OCT and MCI. The study included 16 eyes of 16 patients (14 males). Age of presentation ranged from 7 to 56years and presenting vision ranged from 6/6 to 6/24. On OCT, increased reflectivity and obliteration of hyporeflective ellipsoid zone (EZ) and interdigitation zone (IZ) at CR region were seen. Fovea and other retinal layers were spared. On MCI, white areas due to hyperreflectance corresponding to CR were noted on individual colour reflectance channels and on composite multicolour image. In all cases, foveal reflectance pattern was unaffected. The affection of the EZ and IZ at the CR on OCT was associated with increased reflectance on individual wavelength colour channels on MCI. Foveal sparing on MCI correlated with photoreceptor layer sparing at the fovea on OCT. In 6 (38%) cases with follow-up details, normal reflectivity of EZ and IZ was noted in the region of previous CR as early as 1-week post-presentation. White coloration on multicolour image showed resolution. Foveal sparing was common and rod-dominated areas were affected in CR. Corresponding changes on MCI showed hyperreflectance areas on individual wavelength colour channels. Studies combined with photoreceptor-specific electrophysiological tests, adaptive optics imaging and histological evidences would be required in future.

Traumatic Optic Neuropathy Aggravated by Orbital Emphysema after Orbital Fracture

Purpose: To report a case of traumatic optic neuropathy aggravated by orbital emphysema after an orbital fracture.Case summary: A 19-year-old man with no specific medical history was referred for a right orbital fracture caused by blunt trauma to the supraorbital rim of the right eye. Computed tomography (CT) showed a right orbital fracture involving the inferomedial wall and inferomedial strut. The corrected visual acuity was 0.4 in the right eye (RE) and 1.0 in the left and the intraocular pressure was 15 and 18 mmHg, respectively. Restriction on downgaze, abduction, and an indefinite relative afferent pupillary defect (RAPD) were observed in the RE. Fundus exam was non-specific other than commotio retinae on the temporal side of the macula in the RE. After 12 hours post trauma, the visual acuity of the RE had decreased to light perception. Definite RAPD was observed with optic disc swelling on the fundus photo and optical coherence tomography. Orbital CT showed air shadows, which were not seen on the initial evaluation, adjacent to the optic disc. We diagnosed traumatic optic neuropathy aggravated by orbital emphysema. High-dose intravenous steroid was given for 3 days. Despite a lateral canthotomy and cantholysis to decompress the right orbit, visual acuity did not improve above counting fingers.Conclusions: Increased intraorbital pressure and congestion caused by orbital emphysema may exacerbate traumatic optic neuropathy. Therefore, close observation is required.

Significance of subconjunctival hemorrhage in predicting ocular pathology for patients with orbital fracture

ObjectifIl n'est pas rare qu'une hémorragie sous-conjonctivale (HSC) apparaisse au décours d'un traumatisme orbitaire, ce qui motive souvent la recherche de lésions oculaires sous-jacentes. Notre étude visait à évaluer l'importance de la gravité de l'HSC – mesurée en fonction d'un cercle de 0 à 360° – à titre de facteur prédictif de lésions oculaires chez des patients qui ont subi une fracture orbitaire. NatureÉtude rétrospective de dossiers médicaux. ParticipantsPatients qui ont subi une fracture orbitaire (n = 265) et qui se sont présentés à un centre de traumatologie de niveau 1 entre août 2015 et janvier 2018. MéthodesOnt été notés les éléments clés de l’évaluation ophtalmologique, soit l'acuité visuelle, l'HSC (0–360°), les résultats de l'examen des segments antérieur et postérieur, les mesures obtenues à l'exophtalmomètre de Hertel et le type de lésion oculaire. On a eu recours à une régression logistique simple afin d’évaluer le lien entre la gravité de l'HSC et les lésions oculaires. Les rapports de cotes (RC) ont été calculés avec un intervalle de confiance (IC) à 95 %. RésultatsSur les 265 fractures orbitaires, 158 (59,6 %) ne s'accompagnaient d'aucune HSC, contrairement à 107 (40,4 %) qui présentaient un certain degré d'HSC. On a noté des lésions oculaires parallèlement à 24 fractures orbitaires (9 %). Les lésions les plus fréquentes étaient le piégeage (22,2 %), l'hyphéma (16,7 %), la neuropathie optique traumatique (8,3 %) et la commotion de la rétine (8,3 %). La régression logistique simple a mis au jour une incidence plus élevée de lésions oculaires à mesure que s'aggravait l'HSC (de 0 à 360°; RC : 1,004; IC à 95 % : 1,001–1,007; p = 0,0085). De plus, l'analyse du χ2 a mis au jour une proportion plus élevée de lésions oculaires dans les sous-groupes d'HSC 181–270° (25,0 %; p = 0,0466) et 271–360° (26,3 %; p = 0,0031), comparativement au sous-groupe d'HSC 0° (6,3 %). ConclusionsSi l'on se fie à nos résultats, il existe une certaine corrélation entre l'importance de l'HSC et les lésions oculaires. Cela dit, la prise en charge des traumatismes orbitaires, qu'il s'agisse de soins ou d'examens complémentaires, doit continuer de reposer sur une évaluation clinique approfondie.

Evaluation of commotio retinae in orbital fractures.

This study aimed to evaluate the mechanisms of injury and types of orbital fractures and their relation to concurrent commotio retinae. This retrospective study evaluated the records of patients with orbital fractures whose diagnoses had been confirmed by computer tomography between July 2017 and September 2019. Patient demographics, the circumstances of injury, ophthalmic examination results, and radiological findings were tabulated. Statistical analysis of the data used two-tailed student's t-tests, chi-squared tests, and odds ratio calculations. Statistical significance was set at p<0.05. Of the 204 patients with orbital fractures included in this study, 154 (75.5%) were male. The mean age was 42.1 years. Orbital fractures involving one orbital wall (58.8%) were more common than those affecting multiple walls (41.2%). The majority of fractures affected the inferior wall (60.3%), with the medial walls being the next most frequently affected (19.6%). The most common cause of injury was assault (59.3%), and the second most common was falls (24%). Commotio retinae was observed in 20.1% of orbital fracture cases and was most associated with injuries caused by assault (OR=5.22, p<0.001) and least associated with those caused by falls (OR=0.06, p<0.001). Eye movement restrictions were more common in central than peripheral commotio (OR=3.79, p=0.015) and with medial wall fractures than fractures to other orbital walls (OR=7.16, p<0.001). The odds of commotio were not found to be higher in patients with multi-walled orbital fractures than in those with single-walled fractures (p=0.967). In the study population, assault was the most common cause of orbital fractures and resulted in commotio retinae than other causes. Ophthalmologists should be aware of the likelihood of commotio retinae in patients with orbital fractures resulting from assault, regardless of the extent of the patient's injuries.

Successful management of an unusual extra-ocular foreign body.

A 25 yr old male†, industrial worker by profession, presented to the emergency setting of Government Medical College, Chandigarh, in July 2020, with a rare foreign body impaction. This was after he sustained occupational ocular trauma while cutting iron sheets with a manual work tool machine. He was not wearing any ocular protective gear. Ocular examination revealed impaction of multiple round brass foreign bodies in the right lower lid (Fig. 1A) and closed globe injury to the globe with vitreous haemorrhage and peri-papillary retinal pallor (Fig. 1B). Non-contrast computed tomography orbit showed metallic foreign bodies abutting the globe but not causing globe rupture (Fig. 2A: axial view; Fig. 2B: coronal view; Fig. 2C: sagittal view). The foreign bodies were removed (Fig. 1. inset) and the lid and canalicular repair was done. Pars plana vitrectomy was done to clear the vitreous haemorrhage. During the procedure, fibrogliotic bands with pigmentary alterations and multiple retinal breaks were noticed inferonasally due to coup injury at the site of the impact. Differential diagnoses of chorioretinitis sclopetaria, choroidal rupture and commotio retinae were kept in mind. The breaks in the region of chorioretinitis sclopetaria were lasered using a 532 nm laser. At 12 months of follow up, the visual acuity was 20/40 with attached retina (Fig. 3A and B) and no complaints of epiphora were noted. To the best of our knowledge, the impaction of multiple foreign bodies with stacking in the extra-ocular space has not been reported previously in the spectrum of work-tool related eye injuries. A team approach by oculoplastic and retina surgeons may be required for successful management of complex occupational ocular trauma.Fig. 1: (A) Photograph showing three metallic foreign bodies stacked one above the other in the lower eyelid in the medial aspect. (B) Fundus picture showing diffuse retinal opacification around optic disc and the fundus details are masked by overlying vitreous haemorrhage (inset). Photograph showing three (two are stacked together) 15 mm round smooth disc-shaped brass foreign bodies removed from the orbit.Fig. 2: Computed tomographic scan showing metallic foreign body in the inferior orbit abutting the globe with intact inferior wall of the orbit (A, axial scan, B, coronal scan, C, sagittal scan).Fig. 3: (A) Follow-up facial photograph of the patient showing repaired eyelid after removal of the foreign bodies with puncta well opposed to the globe. (B) Fundus montage of the right eye, after pars plana vitrectomy showing inferonasal chorioretinitis sclopetaria (arrow) with laser done for retinal breaks (arrowheads).Conflicts of Interest: None.