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Question: Eye Trauma

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A 16yo boy presents with chief complaint of a black “hole” in the center of his vision in his right eye 4 days after being hit by a baseball to the eye. He has periorbital ecchymosis but no evidence of orbital fracture. Visual acuity is 20/60 on right, 20/20 on left. He is PERRL, EOMI without pain, and has normal IOP and slit lamp exam. Fundoscopic shows a deep subretinal hemorrhage in his macular area with a small curvilinear yellow line visible.

What is the correct management other than consulting ophthalmology?

pemsou5_wp • July 30, 2019

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  1. Kelly July 30, 2019 - 2:43 pm Reply

    D) Close follow-up with ophthalmologist
    Traumatic choroid rupture may occur due to any traumatic injury to the eye; sports-related injuries are common. The retina is often spared due to its elasticity, the sclera due its rigidity, and the choroid is what ruptures. Subretinal hemorrhage often initially obscures the choroid rupture, which appears as a curvilinear yellow line on fundoscopic exam; the line is more apparent as the blood is resorbed. Patients may present with a variety of visual field defects, depending on the location of the rupture. There is no treatment, but patients must be monitored for healing and the vision-threatening complication of choroidal neovascularization.

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