Delayed visual loss after blunt head trauma

The present work describes the presentation, etiology, diagnosis, and management of delayed visual loss, a severe though rare complication of blunt head trauma. Delayed visual loss is manifested by the occurrence of blindness days to months after the traumatic event. This crucial time interval can preclude appropriate treatment. There are no definitive methods to predict its possible appearance, nor is there a well-defined therapeutic approach. A high index of suspicion is important for timely diagnosis and treatment.     

Delayed orbital subperiosteal hemorrhage after blunt trauma

A 21-year-old man presented with sudden-onset orbital hemorrhage, vision loss, and epistaxis 4 days after experiencing blunt trauma. Computed tomography revealed a subperiosteal hematoma in the medial orbit, extending to the orbital apex, and fractures of the medial and inferior orbital walls. After the hematoma was evacuated through a medial orbitotomy, orbital and visual symptoms improved. Although rare, vision-threatening subperiosteal hemorrhages may develop days after blunt orbital trauma and may require surgical evacuation.     

眼挫伤后一过性近视临床分析

目的探讨眼挫伤后一过性近视的发生机制。方法收集眼挫伤后一过性近视26例(26眼),并对其临床特征和发病机制进行分析。结果小瞳检影验光发现所有外伤眼均存在近视,其中96%的外伤眼表现为轻、中度近视。睫状麻痹剂散瞳后验光发现所有外伤眼的近视度数均显著减轻。经合适的凹透镜矫正后所有外伤眼视力均可达1.0。对症治疗后4周内所有外伤眼的视力均恢复至≥1.0。结论当眼挫伤眼部检查未见明显阳性体征,而又主诉视力下降时,应进行屈光检查,以确定有无眼挫伤后一过性近视的存在。外伤性一过性近视病程短,对药物治疗反应好,且预后佳。     

Optic disc pit maculopathy after blunt ocular trauma

PURPOSE: To present a symptomatic optic pit 3 months after a blunt ocular trauma. METHODS: A 16-year-old male with unilateral decreased vision was examined with multiple cross-sectional scans using optical coherence tomography (OCT) and kinetic ultrasound at the optic disc and macula. RESULTS: Visual acuity was 20/30 OD and 20/20 OS. Fundus examination OD demonstrated an optic pit with a corresponding serous macular detachment. OCT disclosed a schisis-like separation of the inner retinal layer emanating from the optic disc and an outer layer detachment of the retina. B-scan ultrasound disclosed attached Choquet's canal at the optic pit. CONCLUSIONS: Patients with optic pit and firm adherent posterior vitreous may develop schisis-like retinal detachments after blunt ocular trauma.     

Blood-retinal barrier after blunt trauma to the eye

The competence of blood retinal barrier at the level of retinal pigment epithelium (RPE) and retinal capillaries was studied 30 min, 24 h, 3 days, and 7 days after experimental blunt eye injury in the pig, using horseradish peroxidase (HRP). Leakage of HRP into the outer retinal layers was observed in association with disrupted RPE in the first three days after injury. No HRP leakage was seen 7 days after the trauma and the retinal vessels remained competent throughout the study. It is suggested that extracellular edema occurs in the early stages of commotio retinae due to the disruption of blood retinal barrier at the level of the RPE. Present address: Estelle Doheny Eye Foundation, 1355 San Pablo Street, Los Angeles, California 90033, USA     

Persistent infra-orbital nerve hyperaesthesia after blunt orbital trauma

Background: Hyperaesthesia involving the infra-orbital nerve is rarely associated with orbital floor fracture. Methods: An 11-year-old boy and a 34-year-old man had persistent and severe hyperaesthesia in the distribution of the infra-orbital nerve 12 and 26 months, respectively, after blunt orbital trauma. Results: Surgical decompression of the infra-orbital nerve resulted in rapid and complete resolution of the hyperaesthesia in both cases. Conclusion: Persistent hyperaesthesia of the infra-orbital nerve is another indication for exploration of the orbital floor following blunt orbital trauma.     

Aspirin and recurrent hyphema after blunt ocular trauma

Recurrent hyphema after traumatic blunt injury to the eye is associated with a more serious prognosis than that occurring from the initial trauma, resulting in a higher risk of glaucoma, corneal staining, surgical intervention, poor visual acuity, and enucleation. Risk factors associated with the development of recurrent bleeding are not well defined, but recent evidence suggests a high association with concurrent aspirin ingestion. Of 25 consecutive patients with hyphemas (20 males and five females, ranging in age from 2 to 53 years), 12 took aspirin after the initial trauma and seven had recurrent hyphemas. Platelet aggregation determinations in these seven patients showed defects associated with aspirin. Only one of 13 patients without aspirin intake had recurrent bleeding.     

Pupillary capture of implantable contact lens after blunt trauma

A 33-year-old woman visited our clinic with blurry vision and periorbital swelling after experiencing blunt trauma to left eye. Ten months earlier, she had implantable contact lens (ICL) implantation in the left eye. Biomicroscopic examination showed that that 1 footplate of the ICL was entrapped in the pupillary aperture at the 7 o'clock position and the ICL was placed vertically. The patient had limited ocular movement in lateral gaze, and the computed tomography showed a medial orbital wall fracture. Pupillary capture of the ICL was surgically corrected with an iris manipulator under topical anesthesia. After the ICL was repositioned, the patient's uncorrected visual acuity was restored to 20/32, as before the injury. Pupillary capture of the ICL may occur after blunt ocular trauma.     

Pathogenesis of transient high myopia after blunt eye trauma

OBJECTIVE: To determine the pathogenesis of transient high myopia after blunt eye trauma. DESIGN: Two observational case reports and literature review. METHODS: Refraction was measured in two patients with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The anterior chamber angle, the ciliary body, and the choroid were examined by ultrasound biomicroscopy (UBM) in the acute and convalescent stages. In one patient, the anterior chamber depth, lens thickness, and axial length were measured by A-scan ultrasonography in the acute and convalescent stages. MAIN OUTCOME MEASURES: Comparison of the refraction, anterior chamber depth, lens thickness, axial length, and the UBM-determined appearance of the choroid and ciliary body during the acute stage with the values during the convalescent stages. RESULTS: The first patient showed a myopic shift of -9.75 diopters (D) and an anterior chamber shallowing of 0.94 mm measured 3 days after trauma by an air bag inflation compared with the measurements at the convalescent phase. UBM showed an annular ciliochoroidal effusion with ciliary body edema, anterior rotation of the ciliary processes, and disappearance of the ciliary sulcus. Eleven days after the injury, these UBM findings normalized, and the myopia decreased to -0.75 D, 27 days after trauma. The second patient had a myopic shift of -8.9 D compared with the convalescent phase, immediately after blunt trauma by a firework. Seven days after the injury, UBM revealed a partial cyclodialysis in addition to findings similar to those in the first patient. Ten days after injury, a myopic shift (-4.75 D), anterior chamber shallowing (by 1.1 mm), and thickening of the crystalline lens (by 0.27 mm) were observed compared with the convalescent phase. Associated UBM findings confirmed the anterior shift of the lens-iris diaphragm. Seventeen days after trauma, the UBM findings, including the cyclodialysis, were normalized, and the myopia had decreased to -1.0 D. CONCLUSIONS: Transient high myopia after blunt trauma is caused by anatomic changes in the ciliary body and crystalline lens. The anterior shift of the lens-iris diaphragm caused by ciliochoroidal effusion with ciliary body edema and thickening of the crystalline lens from blunt eye trauma are involved in traumatic high myopia.     

青少年眼钝伤性房角后退的观察

目的本文观察282例眼钝位对房角损伤所致房角后退的各种状态,并探讨房角后退与前房出血及青光眼的关系.方法应用Goldmann前房角镜,检查282例眼钝伤的双眼前房角,观察房角后退的各种形态,根据Howard等的分类法将房角后退分成浅(Ⅰ度),中(Ⅱ度),深(Ⅲ度)三度,并以圆周0～360°范围作记录.结果各种原因所致282例钝伤眼中,267眼有房角后退占94.68%,其中Ⅰ度房角后退119眼(44.57%),Ⅱ度95眼(35.58%),Ⅲ度53眼(19.85%).有前房出血记录者198眼(70.21%),全部有房角后退.在房角后退的267眼中,41眼有眼压升高,其中17眼房角后退为唯一原因,眼压升高均发生在1年内,大部分在1周内.其中16眼经药物治疗后1年内眼压恢复正常,1眼手术治疗.结论眼钝伤做房角镜检查,有利于发现房角损伤,并综合各种损伤分析病情,指导临床治疗.若发现房角后退＞180°时,有可能发生青光眼,应定期随诊.     

睫状体挫伤的形态学研究

目的探讨严重眼球伤后睫状体各种损伤形态的特点。方法应用超声生物显微镜(ultrasoundbiomicroscopy,UBM)检查眼挫伤连续病例共196例(202)眼。结果109例(121眼,59.90%)有睫状体的损伤,包括:房角后退42例(42眼,20.79%);睫状体分离28例(30眼,14.85%);睫状体脉络膜脱离31例(31眼,15.35%);睫状体脉络膜上腔积血12例(12眼,5.94%);睫状体上皮脱离3例(3眼,1.49%);睫状体破裂3例(3眼,1.49%)。结论眼挫伤后睫状体的损伤多种多样,UBM检查能提供这些损伤的清楚图像,是正确地诊断这些损伤的无创伤性检查方法。