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Published on: November 12, 2020
Central retinal artery occlusion following pediatric blunt ocular trauma
Sivaranjan Ramachandran1, Kasturi Chavan1, Tapas R Padhi1
1Vitreoretina Services, Anant Bajaj Retina Institute, LV Prasad Eye Institute, Bhubaneswar, Odisha, India.
Insights
Central retinal artery occlusion (CRAO) in children after blunt trauma is a significant cause of vision loss. Reflex vasospasm is the most common cause, and early disk pallor indicates vascular compromise.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Trauma Research
Background:
- Blunt trauma in pediatric subjects can lead to central retinal artery occlusion (CRAO).
- Understanding the clinical profile, pathophysiology, and outcomes of pediatric CRAO post-trauma is crucial.
Purpose of the Study:
- To analyze the clinical profile, presentation, pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects.
Main Methods:
- Retrospective analysis of medical charts for 11 pediatric patients (≤18 years) diagnosed with CRAO post-blunt ocular trauma.
- Literature review using Medline with keywords: central retinal artery occlusion, blunt trauma, children, pediatric subjects, adolescents.
Main Results:
- 11 male patients (mean age 14.3 years) presented with CRAO 8.1 days post-trauma.
- Visual acuity varied from no light perception to finger count; 6 eyes showed disk pallor within 12 days.
- Two cases had coexisting optic nerve avulsion; none had bony fractures on CT scan.
Conclusions:
- Central retinal artery occlusion (CRAO) is a key cause of visual impairment in children after blunt trauma.
- Reflex vasospasm is the most frequent etiology.
- Early disk pallor suggests compromised retinal and optic disk circulation, potentially alongside direct disk injury.
Background:
To analyze the clinical profile, presentation, possible pathophysiology, and outcomes of central retinal artery occlusion (CRAO) following blunt trauma in pediatric subjects.
Methodology:
The medical charts of subjects aged 18 years or less with a diagnosis of CRAO following blunt ocular trauma were analyzed retrospectively for demography, details of the trauma, ocular findings, additional imaging reports if any, and final outcome. A Medline search was done (key words like central retinal artery occlusion, blunt trauma, children, pediatric subjects, and adolescents) to gather information available in the literature on the subject.
Results:
A total of 11 patients (11 eyes), mean age of 14.3 ± 3.4 years, and 100% male preponderance, with an average time duration from trauma to presentation to the hospital of 8.1 days were included. Visual acuity ranged from no light perception (four eyes) to finger count at a 1 m distance. Intraocular pressure was raised in three patients, of which two were suffering from sickle cell disease. In two eyes, the CRAO coexisted with optic nerve avulsion and the cilioretinal artery was spared. Disk pallor was seen in six eyes as early as 12 days from the trauma. None of the cases revealed any bony fracture in the CT scan.
Conclusion:
CRAO was observed to be an important primary or contributory cause of visual loss in children following blunt trauma, reflex vasospasm being the most common etiology. Early onset disk pallor could suggest an underlying vascular compromise of both retinal and optic disk circulation in addition to direct disk damage.
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