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Commotio Retinae

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Title: Commotio Retinae
Author: Joanna Gorka, BS
Date: 8/5/24
Keywords/Main Subjects: commotio retinae, blunt globe trauma, retinopathy, OCT
Diagnosis: Commotio Retinae

Description of Case:

Introduction
Commotio retinae, derived from the latin word commōtus referring to ‘disturbance’ or ‘agitation’ is a traumatic retinopathy secondary to direct or indirect trauma to the globe.

Case
A 42-year-old male presented with diminished vision and sharp pain in the left eye one day after blunt trauma via metal hook of a bungee cord. He reported a complete loss of vision in the eye immediately following the injury which shortly after improved to blurriness with diminished superior visual field. On evaluation, visual acuity was 20/40. No corneal lacerations were appreciated. Fundus exam revealed commotio of the temporal/inferior retina, significant retinal mottling, and scattered pre-retinal hemorrhage.

One-week post-injury, the patient returned to clinic with worsened vision, 20/60. OCT was notable for slight hyperreflectivity to the outer retina consistent with commotio. 2 months later, the patient’s visual acuity recovered to 20/20. Post-traumatic peripheral retinal pigmentary changes were present 4 months post-injury.

Images:

Day 0: 20/40. Multilayered hemorrhage inferior/temporal and retinal whitening consistent with commotio retinae.

 

2 weeks: 20/60. Slight hyperreflectivity to outer retina consistent with commotio.

 

2 months: 20/20. Temporal/inferotemporal pigmentary changes with subretinal hemorrhage. Temporal small area of localized elevation.

 

4 months: 20/20. Temporal/inferotemporal pigmentary changes with flattened old blood inferiorly. Temporal small area of localized vitreous fibrosis over retina.

Summary of the Case: Commotio retinae is a self-limited retinopathy secondary to blunt globe trauma that is often characterized by retinal whitening.1 OCT may show increased reflectivity and thickness of the ellipsoid zone. Ahn et al. developed a 4-step grading system for prognosis based on OCT findings. OCT findings in this patient case are consistent with Grade 1 findings which are associated with the highest likelihood of visual and anatomic recovery.2 Patients with commotio retinae should be followed with serial examinations and monitored for the development of macular holes.3 There is no indicated medical treatment for commotio retinae, and most patients experience full recovery.4

 

References: BLANCH, R.J., UNDERSTANDING AND PREVENTING VISUAL LOSS IN COMMOTIO RETINAE, in College of Medical and Dental Sciences. 2014, University of Birmingham: Birmingham, UK. p. 581.

  1. Ahn, S.J., et al., Optical coherence tomography morphologic grading of macular commotio retinae and its association with anatomic and visual outcomes. Am J Ophthalmol, 2013. 156(5): p. 994-1001.e1.
  2. David Browning, M.P. What You Should Know About Blunt Trauma to the Eye: Commotio Retinae, Hyphema, Lens Dislocation, Vitreous Hemorrhage, Retinal Breaks, and Early and Late Glaucoma.  [cited 2016 May 30th, 2016]; Available from: http://www.retinareference.com/diseases/9c563c5794aacd24/documents/9c563c5794/document.pdf.
  3. Blanch RJ, Good PA, Shah P, Bishop JR, Logan A, Scott RA. Visual outcomes after blunt ocular trauma. Ophthalmology. 2013 Aug;120(8):1588-91. doi: 10.1016/j.ophtha.2013.01.009. Epub 2013 Apr 22. PMID: 23618228.

 

Faculty Approval by: Paul S. Bernstein, MD, PhD

Copyright statement: Joanna Gorka, ©2024. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/