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Bilateral retrobulbar hemorrhage and visual loss following traumatic asphyxia.

Choi YJ, Lee SJ, Kim HJ, Yim JH - Korean J Ophthalmol (2010)

Bottom Line: An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema.Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed.Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.

ABSTRACT
Retrobulbar hemorrhage and permanent visual loss are rare presentations following traumatic asphyxia. In this case, bilateral permanent visual disturbance developed in a woman after chest-crushing trauma without direct trauma to the orbits. A computed tomography scan confirmed bilateral retrobulbar hemorrhages. An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema. Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed. Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.

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Admission axial computed tomography scans of the orbit demonstrated bilateral retrobulbar hemorrhages, mild proptosis, and severe eyelid swelling. Note the orbital fat interposed between the globe and medial wall of the orbit.
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Figure 2: Admission axial computed tomography scans of the orbit demonstrated bilateral retrobulbar hemorrhages, mild proptosis, and severe eyelid swelling. Note the orbital fat interposed between the globe and medial wall of the orbit.

Mentions: A 47-year-old woman working in a car manufacturing plant was pinned between a conveyer belt and the car body during assembly. Her left shoulder and chest were compressed. When released more than 20 minutes later, she was unconscious. Upon arriving at the emergency department, she was still unconscious, with facial cyanosis, severe edema, and petechiae. Radiographs and computed tomography (CT) scans of her chest, abdomen, and head revealed bilateral pneumothoraces, hemothoraces, multiple rib fractures, and a left scapular fracture. Her blood pressure was unstable. There were no other signs or history of head injury. A closed thoracotomy was immediately performed in the emergency room, and she was transferred to the intensive care unit for further management. In a bedside ophthalmologic examination, severe bilateral subconjunctival hemorrhages, chemosis, severe periorbital swelling, and mild exophthalmos were found (Fig. 1). Both pupils reacted sluggishly to light, and there was a relative afferent pupillary defect in the left eye. Intraocular pressure measured by a Tono-Pen was 17 mmHg in the right eye and 16 mmHg in the left eye. There were no signs of orbital compartment syndrome. Funduscopic examination showed bilateral mild optic disc edema. Admission axial CT scans of the orbit demonstrated bilateral retrobulbar hemorrhages, mild proptosis, and severe eyelid swelling (Fig. 2). Follow-up CT scans obtained 3 days later showed reduced exophthalmos and retrobulbar hemorrhages. On the third day after the accident, the patient recovered consciousness and her corrected visual acuity was finger counting at 50 cm in the right eye, and hand motion in the left eye. Visual evoked potentials revealed bilateral delayed latency, decreased amplitude in the right eye, and a flat wave in the left eye. High-dose steroid therapy was begun with the intravenous injection of 1.0 g methylprednisone daily for five days. Seven days after course of steroid treatment, corrected visual acuity improved to 0.1 in the right eye, but there was a marked visual field defect, and the corrected visual acuity of her left eye remained hand motion without recovery (Fig. 3).


Bilateral retrobulbar hemorrhage and visual loss following traumatic asphyxia.

Choi YJ, Lee SJ, Kim HJ, Yim JH - Korean J Ophthalmol (2010)

Admission axial computed tomography scans of the orbit demonstrated bilateral retrobulbar hemorrhages, mild proptosis, and severe eyelid swelling. Note the orbital fat interposed between the globe and medial wall of the orbit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992570&req=5

Figure 2: Admission axial computed tomography scans of the orbit demonstrated bilateral retrobulbar hemorrhages, mild proptosis, and severe eyelid swelling. Note the orbital fat interposed between the globe and medial wall of the orbit.
Mentions: A 47-year-old woman working in a car manufacturing plant was pinned between a conveyer belt and the car body during assembly. Her left shoulder and chest were compressed. When released more than 20 minutes later, she was unconscious. Upon arriving at the emergency department, she was still unconscious, with facial cyanosis, severe edema, and petechiae. Radiographs and computed tomography (CT) scans of her chest, abdomen, and head revealed bilateral pneumothoraces, hemothoraces, multiple rib fractures, and a left scapular fracture. Her blood pressure was unstable. There were no other signs or history of head injury. A closed thoracotomy was immediately performed in the emergency room, and she was transferred to the intensive care unit for further management. In a bedside ophthalmologic examination, severe bilateral subconjunctival hemorrhages, chemosis, severe periorbital swelling, and mild exophthalmos were found (Fig. 1). Both pupils reacted sluggishly to light, and there was a relative afferent pupillary defect in the left eye. Intraocular pressure measured by a Tono-Pen was 17 mmHg in the right eye and 16 mmHg in the left eye. There were no signs of orbital compartment syndrome. Funduscopic examination showed bilateral mild optic disc edema. Admission axial CT scans of the orbit demonstrated bilateral retrobulbar hemorrhages, mild proptosis, and severe eyelid swelling (Fig. 2). Follow-up CT scans obtained 3 days later showed reduced exophthalmos and retrobulbar hemorrhages. On the third day after the accident, the patient recovered consciousness and her corrected visual acuity was finger counting at 50 cm in the right eye, and hand motion in the left eye. Visual evoked potentials revealed bilateral delayed latency, decreased amplitude in the right eye, and a flat wave in the left eye. High-dose steroid therapy was begun with the intravenous injection of 1.0 g methylprednisone daily for five days. Seven days after course of steroid treatment, corrected visual acuity improved to 0.1 in the right eye, but there was a marked visual field defect, and the corrected visual acuity of her left eye remained hand motion without recovery (Fig. 3).

Bottom Line: An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema.Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed.Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea.

ABSTRACT
Retrobulbar hemorrhage and permanent visual loss are rare presentations following traumatic asphyxia. In this case, bilateral permanent visual disturbance developed in a woman after chest-crushing trauma without direct trauma to the orbits. A computed tomography scan confirmed bilateral retrobulbar hemorrhages. An ophthalmologic exam revealed bilateral subconjunctival hemorrhages and severe lid edema. Despite high-dose steroid therapy, visual recovery was limited, and optic nerve atrophy developed. Ischemia of the optic nerve associated with retrobulbar hemorrhage may be postulated as one of the causes of permanent visual impairment following traumatic asphyxia.

Show MeSH
Related in: MedlinePlus