|Year : 2019 | Volume
| Issue : 2 | Page : 81-83
Retinitis sclopetaria in blast injury
Maithili Mishra, Sheela P Kerkar, Samruddhi Dani, Priyarthi Pradhan, Bhooshan Gandhi, Sonal S Desai
Department of Ophthalmology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
|Date of Submission||31-Jul-2018|
|Date of Acceptance||27-Mar-2019|
|Date of Web Publication||21-Aug-2019|
Department of Ophthalmology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
A 52-year-old male presented with decreased vision in his left eye for 1.5 years after he suffered from a blast injury at his workplace in a chemical factory. Clinical examination revealed no systemic abnormality; however, ocular evaluation of the left eye showed traumatic mydriasis of the pupil and fundus examination showed multiple choroidal ruptures with extensive scar formation and widespread pigmentary alteration, causing a distinctive pattern of retinitis sclopetaria. Closed globe injury, especially blast injury, which has a high velocity causes a typical pattern of retinal findings. Our patient did not develop retinal detachment even after 1.5 years of trauma; however, macular involvement caused poor vision and prognosis. Spectral-domain optical coherence tomography did not reveal any abnormal choroidal neovascularization. Retinitis sclopetaria is an uncommon entity, and long-term clinical outcomes are not well reported. In this report, we would like to discuss the clinical features seen after a long-standing trauma, injury mechanism, suggested treatment, and prognosis.
Keywords: Blast injury, choroidal rupture, retinitis sclopetaria, traumatic chorioretinitis
|How to cite this article:|
Mishra M, Kerkar SP, Dani S, Pradhan P, Gandhi B, Desai SS. Retinitis sclopetaria in blast injury. J Clin Ophthalmol Res 2019;7:81-3
|How to cite this URL:|
Mishra M, Kerkar SP, Dani S, Pradhan P, Gandhi B, Desai SS. Retinitis sclopetaria in blast injury. J Clin Ophthalmol Res [serial online] 2019 [cited 2019 Sep 21];7:81-3. Available from: http://www.jcor.in/text.asp?2019/7/2/81/264896
The term sclopetaria originates from the English word “sclow” which means to claw or tear, or from the Latin word “sclopetum” which was a Roman gun. It is defined as a full-thickness break of the choroid and retina as a result of a high-velocity missile striking or passing adjacent to, but not penetrating, the globe. Choroidal and retinal ruptures occur in large areas of the retina combined with subretinal and intraretinal hemorrhage. These lesions heal with irregular borders, sometimes with a claw-like configuration. This case is being reported as it is a rare case.
| Case Report|| |
A 52-year-old male, working as a supervisor in a chemical factory, presented with decreased vision in the left eye for 12 months. He had a history of trauma to the left eye from a cylinder blast injury 1.5 years ago. He had not received any ophthalmic consult or treatment before this visit. Clinical examination did not reveal any systemic abnormality. Best-corrected vision in the right eye was 20/20 and in the left eye was 20/400. In the left eye, there was traumatic mydriasis of the pupil and multiple sphincter tears. Fundus examination revealed normal fundus in the right eye; however, in the left eye, there was disc pallor, multiple choroidal ruptures with extensive retinal scarring, and widespread pigmentary alteration in midperiphery and far periphery [Figure 1], [Figure 2], [Figure 3]. As the macula was involved, there was significant visual loss. No retinal breaks nor any other signs of retinal detachment were noted. On clinical examination and spectral-domain optical coherence tomography, there were no signs of choroidal neovascularization. Observation with protective glasses at work was advised, and poor visual prognosis was explained.
|Figure 1: Multiple choroidal ruptures with macular involvement and extensive fibrous subretinal scarring with a pale disc|
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|Figure 2: Multiple choroidal ruptures in the periphery with the underlying sclera exposed and retinal pigment epithelium pigmentation|
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|Figure 3: Multiple choroidal ruptures in the periphery with the underlying sclera exposed and retinal pigment epithelium pigmentation|
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| Discussion|| |
Retinitis sclopetaria, or traumatic chorioretinitis, is a relatively rare condition following high-velocity injuries close to the globe such as gunshot, missile injuries, blast injuries, and even blunt trauma. When a high-velocity projectile passes adjacent to the globe, there are direct and indirect shock wave forces which can lead to simultaneous retraction of the choroid and retina, leaving an area of intact bare sclera. The forces that are generated by the deceleration of the projectile near the sclera cause a full-thickness disruption of the choroid and retina even without penetration of the globe.
Immediately after the injury, there is usually extensive intraocular hemorrhage which eventually resorbs and organizes, leaving a characteristic pattern of choroidal and retinal damage with extensive fibrous proliferation that seems to fuse the retina and the choroid. As the blood resorbs, the injured area heals with a fibrous scar and widespread retinal pigment epithelium alterations.
Management in these cases depends on the extent of damage. Vitrectomy may be required in the setting of visual-axis obscuration due to vitreous hemorrhage. Retinal detachment surgeries are seldom required as the choroid and retina appear to retract as a single unit, preventing the access of fluid to the subretinal space. Furthermore, the posterior hyaloid remains intact over the region of the rupture and may prevent the access of liquefied vitreous in the subretinal space. Ahmadabadi et al. reported the largest series wherein only one of these patients had retinal detachment which was treated with silicone oil tamponade. New breaks may also develop which could require surgery. Besides, trauma causing retinitis sclopteria may also cause other orbital damage. Mackenzie et al. described a case of a patient who in addition to chorioretinitis sclopetaria suffered from a complete traumatic transection of the lateral rectus at the equator of the globe. In another case report, the authors described a concomitant optic nerve transection combined with chorioretinitis sclopetaria. Although Bruch's membrane is destroyed in these cases, interestingly, there is no literature available wherein treatment for choroidal neovascularization is reported for retinitis sclopetaria.
In this case, the patient was examined after long-standing trauma which showed macular involvement and also consecutive optic atrophy probably secondary to the widespread retinal damage. However, as there were no signs of retinal breaks or choroidal neovascularization, observation was advised. Prognosis in these cases generally remains poor with macular involvement.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]