What is the defining injury pattern of chorioretinitis sclopetaria?

Choroid and retina rupture while the sclera stays intact It is a closed globe injury: the choroid and retina rupture full-thickness and retract, while the sclera remains intact.

Full-thickness scleral rupture with chorioretinal prolapse

Chorioretinal inflammation without any tissue rupture

Choroidal break beneath an intact retina

What typically causes chorioretinitis sclopetaria?

A high-velocity projectile passing close to the globe Shock-wave forces from a high-velocity object such as a bullet passing very close to the globe rupture the chorioretinal layers.

An intraocular foreign body lodged in the retina

A chemical injury to the ocular surface

Prolonged unprotected viewing of the sun

What happens to the RPE and photoreceptors in chorioretinitis sclopetaria?

RPE becomes hyperplastic; photoreceptors are extensively lost After the rupture and vitreous haemorrhage, the retinal pigment epithelium undergoes hyperplasia with extensive loss of photoreceptors.

RPE atrophies; photoreceptors are preserved

Both remain intact beneath the rupture

RPE detaches serously; photoreceptors swell

How are the borders of the scar in chorioretinitis sclopetaria described?

Irregular, like a claw As the blood clears, fibrous tissue and then dense connective tissue form a scar whose irregular borders resemble a claw.

Smooth and round, like a punched-out lesion

Crescent-shaped and concentric to the disc

Radial, like the spokes of a wheel

Which dilated fundus finding is characteristic of chorioretinitis sclopetaria?

Bare sclera with adjacent retinal and choroidal tearing Fundus findings include areas of bare sclera with adjacent tearing of the retina and choroid, plus vitreous and subretinal haemorrhage.

Bone-spicule pigment in the midperiphery

Cherry-red spot with retinal whitening

Yellow subretinal drusenoid deposits

Why is retinal detachment uncommon in chorioretinitis sclopetaria?

Scarring at the impact site is thought to prevent it Scar formation at the impact site is believed to prevent detachment, so the risk is very low unless the orbital injury is severe.

The vitreous is always already detached

Raised intraocular pressure tamponades the retina

Prophylactic laser is routinely applied

What does fluorescein angiography show at the rupture site in chorioretinitis sclopetaria?

Hypofluorescence Fundus fluorescein angiography shows hypofluorescence in the area of the chorioretinal rupture.

Lacy neovascular hyperfluorescence

What does B-scan ultrasonography add in the workup of chorioretinitis sclopetaria?

Shows vitreous haemorrhage and retinal detachment B-scan ultrasonography visualises vitreous haemorrhage and retinal detachment, while OCT shows the choroidal rupture and RPE.

Measures the retinal nerve fibre layer

Maps choriocapillaris blood flow

What is the recommended management of chorioretinitis sclopetaria?

Observation, with surgery only for complications There is no specific treatment; patients are observed, and surgery is reserved for complications such as retinal detachment.

Urgent scleral buckling in every case

Intravitreal anti-VEGF injections

High-dose systemic corticosteroids

What is the expected visual effect of surgery for complications of chorioretinitis sclopetaria?

It may not improve visual acuity Even when surgery is performed for complications such as retinal detachment, it may not improve visual acuity.

Vision improves once the scar forms

Early surgery guarantees full recovery

Chorioretinitis Sclopetaria: case study, diagnosis and management

CASE REPORT

A 12- year- old boy with a history of BB gun injury to his right eye was referred for loss of vision. His visual acuity was counting fingers at one meter in the right eye and with 3+ relative afferent pupillary defect (RAPD).

On slit lamp examination, the right eye appeared normal except for a 1+ vitreous reaction. Fundus examination of the right eye revealed a pale disc with a superior retinal scar and diffuse submacular fibrosis compatible with chorioretinitis sclopetaria.

DISEASE

Chorioretinitis sclopetaria is a closed globe injury causing a full-thickness rupture of the choroid and retina due to blunt trauma from a high-velocity object such as a bullet passing very close to the globe.

Chorioretinal layers split and retract from the sudden strike of the object while the sclera remains intact. Chorioretinitis sclopetaria is a type of coup injury which means the damage is present at the site of impact.

When a high-velocity object passing adjacent to the globe, the direct and indirect shock waves forces cause the chorioretinal layer to rupture followed by vitreous hemorrhage. The retinal pigment epithelium undergoes hyperplasia with extensive loss of photoreceptors.

Later on, when the blood absorbs the white fibrous tissue is formed at the site of rupture which is then replaced with dense connective tissues resulting in scarring. The scar has irregular borders like a claw. There is no open globe injury and Intraocular pressure remains within normal limits.

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Signs and symptoms of Chorioretinitis Sclopetaria

The decrease in vision and severity of pain depend upon the site of rupture. The patient either complains of blurry vision or loss of vision.

Other findings on dilated fundus examination are areas of bare sclera with adjacent tearing of the retina and choroid, vitreous and subretinal hemorrhages, macular edema, choroidal breaks, and disc edema. After some days fibrous tissues can be seen at the site of chorioretinal hemorrhage on fundus examination when blood is completely reabsorbed.

It is believed that the scar formation at the site of impact would prevent retinal detachment. That’s why in chorioretinitis sclopetaria, the chances of retinal detachment are very low. However, in case of severe orbital injury, the retina could be detached.

Diagnostic procedures

The detailed fundus examination of chorioretinitis sclopetaria can be performed on a slit lamp. However, there are some other diagnostic instruments that can provide further details

OCT: shows choroidal rupture, the thickness of Retinal pigment epithelium, and retinal detachment.
B-Scan Ultrasonography: visualizes the vitreous hemorrhage and retinal detachment.
Fundus Fluorescein Angiography: shows hypofluoresence in the area of chorioretinal rupture.

Chorioretinitis Sclopetaria MANAGEMENT

There is no specific treatment is available for chorioretinitis sclopetaria. The patient should be kept on observation and in case of complications such as retinal detachment, surgery should be performed.

However, this may not improve visual acuity.

REFERENCES

Sampedro A, Alonso Alvarez C, Ruiz rodriguez M, Usabiaga Bernal JM, Rodriguez vazquez M: Traumatic maculopathies. Arch soc Esp oftalmol. 2001, 76 (1): 57-60.
Dubovy SR, Guyton DL, Green WR: Clinicopathologic correlation of chorioretinitis sclopetaria. Retina. 1997, 17 (6): 510-20.
Ludwig CA, Shields RA, Do DV, et al. Traumatic chorioretinitis sclopetaria: Risk factors, management, and prognosis. Am J Ophthalmol Case Rep. 2019;(39-46):39. doi:10.1016/j.ajoc.2019.02.004.
Shah SU, Prall FR. (2016). Intraorbital Foreign Body Accompanied by Sclopetaria. American Academy of Ophthalmology.
Dubovy SR, Guyton DL, Green WR. Clinicopathologic correlation of chorioretinitis sclopetaria Retina, 17 (6) (1997), pp. 510-520
Sadda SR, Wiedemann P, Hinton DR, Schachat AP, Wilkinson CP. Ryan’s Retina. [Electronic Resource]. [London] : Elsevier, 2018.; 2018.
Blanch R, Ahmed Z, Sik A, et al. (2012). Neuroretinal cell death in a murine model of closed globe injury: pathological and functional characterization.

Test yourself

A few questions straight from this article.

1 / 10 0 correct

What is the defining injury pattern of chorioretinitis sclopetaria?
It is a closed globe injury: the choroid and retina rupture full-thickness and retract, while the sclera remains intact.
What typically causes chorioretinitis sclopetaria?
Shock-wave forces from a high-velocity object such as a bullet passing very close to the globe rupture the chorioretinal layers.
What happens to the RPE and photoreceptors in chorioretinitis sclopetaria?
After the rupture and vitreous haemorrhage, the retinal pigment epithelium undergoes hyperplasia with extensive loss of photoreceptors.
How are the borders of the scar in chorioretinitis sclopetaria described?
As the blood clears, fibrous tissue and then dense connective tissue form a scar whose irregular borders resemble a claw.
Which dilated fundus finding is characteristic of chorioretinitis sclopetaria?
Fundus findings include areas of bare sclera with adjacent tearing of the retina and choroid, plus vitreous and subretinal haemorrhage.
Why is retinal detachment uncommon in chorioretinitis sclopetaria?
Scar formation at the impact site is believed to prevent detachment, so the risk is very low unless the orbital injury is severe.
What does fluorescein angiography show at the rupture site in chorioretinitis sclopetaria?
Fundus fluorescein angiography shows hypofluorescence in the area of the chorioretinal rupture.
What does B-scan ultrasonography add in the workup of chorioretinitis sclopetaria?
B-scan ultrasonography visualises vitreous haemorrhage and retinal detachment, while OCT shows the choroidal rupture and RPE.
What is the recommended management of chorioretinitis sclopetaria?
There is no specific treatment; patients are observed, and surgery is reserved for complications such as retinal detachment.
What is the expected visual effect of surgery for complications of chorioretinitis sclopetaria?
Even when surgery is performed for complications such as retinal detachment, it may not improve visual acuity.