Contusional eye injuries: retinal and choroidal lesions

The fundi of 114 patients were evaluated one to 14 years following contusional eye injury. Most injuries to children occurred at sport and play. Domestic and civil assaults, sporting injuries and industrial accidents were common. Males in the second and third decades of life were predominantly affected. Iris tears, pupillary abnormalities and angle recession were typically associated with the fundal lesions. Contusional injuries of the retina and choroid were found in 92 patients and were graded according to their location, extent and severity. Twenty-six patients (grade 1) had focal or diffuse disturbances of the inner or outer retina. In 15 patients the lesions predominantly affected the receptor-retinal pigment epithelial layers and in six patients there were associated breaks in Bruch's membrane. Five further patients had atrophic inner retinal alterations and lamellar holes at the macula. Most patients in this group retained good visual function. Thirty-six patients (grade 2) had single or multiple choroidal tears. In 21 instances the outer retina was primarily involved; however, in 15 cases there was associated inner retinal damage. Only three patients developed subretinal neovascularisation. Sixteen patients (grade 3) had extensive areas of chorioretinal atrophy associated with retinal pigment epithelial atrophy, proliferation, plaque and membrane formation. Fourteen patients (grade 4) developed retinal holes or tears and 10 proceeded to retinal detachment two weeks to 14 years following injury. Contusional retinal and choroidal lesions have an unfavourable visual prognosis, only 38.6% of patients regaining a visual acuity of 6/12 or better.