Macular infarction and traumatic optic neuropathy following blunt ocular trauma

Abstract

Macular infarction is a visually disabling condition caused by a variety of reasons. It has rarely been described in association with blunt ocular trauma. We describe the case of a young healthy male who sustained injury with a bull's leg and presented with severe visual loss owing to macular infarction and traumatic optic neuropathy. This report of an angiographically documented macular infarct secondary to ocular contusion highlights an additional feature in the spectrum of ocular findings following blunt trauma that might lead to a severe and permanent affliction of vision.

Keywords: Blunt trauma; Macular infarction; Traumatic optic neuropathy.

Figure 1

(a) Fundus photograph of the left eye at presentation showing retinal whitening at the posterior pole with retinal hemorrhages and a cherry red spot. There was an area of subretinal hemorrhage inferior to the disk. (b) Fluorescein angiography demonstrated widening of the foveal avascular zone and abrupt termination of the pre-capillary arterioles, indicating macular infarction. The area below the optic disk showed blocked fluorescence due to the hemorrhage. (c) Late phase of the angiogram showed staining at the optic nerve head, in addition to nonperfusion of the macula. (d) Spectral-domain optical coherence tomography scan through the left macula revealed hyperreflectivity of the inner retinal layers indicating acute ischemia.

Figure 2

(a) Fundus photograph of the left eye at one week follow-up showing decreased retinal whitening and hemorrhages, with foveal thinning. (b) At one month, optic disk pallor was noted with foveal atrophy. (c) Spectral-domain optical coherence tomography scan demonstrated macular thinning.