Retina becomes bullseye for stray dart

Main Article Content

Elise E. Steinberger, MD
Mark Williams, MD
Kristen Collister, MD
Annie Moreau, MD
Reagan Bradford MD

Abstract

Introduction
United States Eye Injury Registry data reports that nearly half of severe ocular trauma involved the retina. Other studies quote incidence of retinal detachment after open globe repair at 29%, with 27% of these detached within 24 hours. Retinal detachment, but not tear, factors into the ocular trauma score (OTS). Definitive treatment of retinal pathology within 48 hours of trauma is associated with better visual acuity outcomes.
Report
A 21-year-old man presented to the emergency room with a full-sized, metal dart penetrating the right orbit and globe. Initial visual acuity measured 20/50 in the right eye without correction. The pupils were round and reactive to light and the anterior segment evaluation of the right eye was unremarkable. Dilation was deferred. CT scan demonstrated intact surrounding orbital bony and soft tissue anatomy. The dart penetrated the superotemporal right upper lid and globe, causing a full-thickness 2 mm scleral laceration, 8 mm from the limbus. OTS was 4, predicting a 74% chance of 6-month visual acuity measuring 20/40 or better. The patient underwent surgical removal of the dart and globe closure, with intravitreal antibiotics. His same day postoperative visual acuity was 20/60 in the right eye without correction, with intraocular pressure of 9 mm Hg and full extraocular motility. A 10 mm superotemporal retinal tear was noted, with adjacent subretinal fluid and vitreous heme. Immediate laser retinopexy (LRP) barricaded the tear and the patient recovered remarkably. Two days following surgery/LRP, visual acuity measured 20/20 in the right eye. Three months later, visual acuity was still 20/20, with an area of vitreoretinal traction being monitored along dart path.
Conclusion
Prompt identification and treatment of retinal pathology in open-globe injuries provides best possibility of preserving and recovering vision.

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How to Cite
1.
Steinberger EE, Williams M, Collister K, Moreau A, Bradford R. Retina becomes bullseye for stray dart. Digit J Ophthalmol. 2024;30. Accessed July 21, 2024. https://djo.harvard.edu/index.php/djo/article/view/1134
Section
Abstracts