Sudden occlusion of the retinal and posterior choroidal circulations in a youth

A 14-year-old boy was stabbed above the left eye and had subsequent loss of both retinal and choroidal perfusion to the posterior segment. Ophthalmoscopic examination ten days after the injury disclosed intense nerve fiber layer edema, most prominent in the posterior pole, and absence of a cherry-red spot. Intravenous fluorescein angiography showed no filling of retinal vessels and only patchy, segmental, peripapillary choroidal filling, probably secondary to collateral circulation developing from the episcleral arterial plexus. Leakage of dye from the peripapillary choroid into the overlying retina was caused by ischemic necrosis of the retinal pigment epithelium. Follow-up examination 11 days later revealed marked sclerosis of the smaller arterioles, optic pallor, atrophic retinal pigment epithelial changes, and loss of retinal substance, most marked in the posterior pole.