CASE REPORT
Case report of Commotio Retinae A 29-year-old woman presented with reduced vision and flickering lights in her left eye when looking up, two days following a high-velocity impact of a champagne cork ejected approximately three meters away.
Her visual acuity was 6/12+2 in the affected eye with a −1.75 D myopic shift relative to the previous refractive status (+0.50/−0.50 × 8, 6/6+) and no improvement with pinhole testing. No signs of traumatic mydriasis were observed, with both pupils equal in size, regular, round and reactive to light.
Confrontation fields and excursions were all unremarkable. Anterior segment biomicroscopy revealed mild superotemporal conjunctival ecchymosis and moderate hyperemia, along with both grade 0.5 cells and flare in the anterior chamber.
Mild lid edema and eyelid ecchymosis were also observed. There was no evidence of other anterior segment injuries, such as corneal trauma, iris tears, hyphaema, or lens opacification.
Gonioscopy showed no signs of angle recession and Goldmann applanation tonometry was 15 mmHg in each eye.
Dilated fundus examination revealed superotemporal peripheral commotio.
DISEASE of Commotio Retinae
Refer to traumatic retinopathy secondary to direct or indirect trauma to the globe. Retinopathy may be present at areas of scleral impact (coup) and or distant sites (contrecoup) including the macula.
When found in the posterior pole is also referred to as Berlin’s edema.
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From Choroida — the team behind this siteMANAGEMENT of Commotio Retinae
Patients suffering substantial ocular trauma with commotio should be followed with serial eye exams to evaluate for any additional treatable conditions.
As commotio of macula resolves, partial or full-thickness macular holes can develop.
Fundus photography is superior to fundus analysis as it enables intraocular pathologies to be photo captured and encrypted information to be shared with colleagues and patients.
Recent technologies allow smartphone-based attachments and integrated lens adaptors to transform the smartphone into a portable fundus camera and Retinal imaging by smartphone.
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From Choroida — the team behind this siteREFERENCES
- Berlin R. Sogenannten commotio retinae. So-called commotio retinae. Klin Monatsbl Augenheilkd 1873;1:42–78.
- 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.
- Hart, J.C., and R. Blight, Commotio retinae. Arch Ophthalmol, 1979. 97(9): p. 1738.
- 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.
- Mansour, A.M., W.R. Green, and C. Hogge, Histopathology of commotio retinae. Retina, 1992. 12(1): p. 24-8.
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Test yourself
A few questions straight from this article.
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Commotio retinae is best defined as which of the following?
The article defines commotio retinae as a traumatic retinopathy secondary to direct or indirect trauma to the globe, not an inherited, inflammatory or occlusive process. -
Commotio retinae involving the posterior pole is also known by which name?
When the retinal changes of commotio retinae are found in the posterior pole, the condition carries the eponym Berlin's edema. -
Where may the retinopathy of commotio retinae appear relative to the site of impact?
Retinopathy may occur at the area of scleral impact (coup) and also at distant contrecoup sites, and the macula can be involved either way. -
Which complication may develop as macular commotio retinae resolves?
Resolution of macular commotio can be followed by a partial-thickness or full-thickness macular hole, so the macula needs re-examination as the whitening fades. -
How should a patient with substantial ocular trauma and commotio retinae be followed?
Commotio itself is followed expectantly; the value of review is repeated examination to pick up additional injuries that are treatable. -
In the reported commotio retinae case, what refractive change was found in the injured eye?
Vision fell to 6/12 with a −1.75 D myopic shift from her earlier refraction, and pinhole testing gave no improvement. -
In the reported commotio retinae case, what did gonioscopy and tonometry show?
Blunt trauma prompts a search for angle recession, but gonioscopy was clear and Goldmann applanation read 15 mmHg in each eye. -
What anterior chamber finding was described in the reported commotio retinae case?
The anterior chamber showed only a trace reaction of grade 0.5 cells and flare, with no hyphaema, iris tears or lens opacity. -
Why is fundus photography favoured over fundus examination alone in commotio retinae?
Photography documents the intraocular findings and lets encrypted images be shared with colleagues and patients, which a written note cannot do. -
What caused the ocular injury in the reported case of commotio retinae?
The 29-year-old woman presented two days after a high-velocity champagne cork struck her left eye from roughly three metres away.
