Delayed-Onset White-Dot Syndrome in the Setting of Traumatic Choroidal Rupture

To describe a patient with a traumatic choroidal rupture and a submacular hemorrhage, the course of which was complicated by delayed-onset posterior uveitis resembling a white-dot syndrome.

A single case was evaluated.

A 34-year-old man presented after being struck in the left eye with a tennis ball. The visual acuity (VA) was 20/30 with otherwise normal ophthalmic vitals. An examination showed traumatic iritis and choroidal rupture with a submacular hemorrhage without subfoveal involvement. Despite treatment of anterior segment inflammation and a worsening hemorrhage with topical agents and intravitreal aflibercept, the VA decreased to 20/600. A repeat examination with optical coherence tomography showed new optic disc edema, placoid outer retinal lesions adjacent to the choroidal rupture, and corresponding ellipsoid zone atrophy. A broad workup was unremarkable, and the patient completed a long taper of high-dose oral prednisone without recurrence.

Traumatic exposure of the immunologically privileged subretinal space to high-flow choroidal circulation likely triggered a pathway involving self-autoantigenicity and a uveitic response.