This 20YO male presented with 1 year of decreased vision in his right eye following blunt trauma from a small pebble that flew off a firecracker blast. Vision was 20/100 OD and 20/20 in his normal left eye.
Color photography shows an inferonasal macular choroidal rupture that extends through the fovea. A faint choroidal rupture is also noted inferior to the nerve. Subtle fluid and blood surround the foveal portion of the rupture. OCT scanning shows a thickened macular neovascularization (MNV) with mild overlying subretinal fluid.
Learning Points:
Choroidal ruptures are caused by blunt ocular trauma and are always circumferential with respect to the optic nerve. Subretinal blood following blunt trauma virtually always indicates the presence of an underlying choroidal rupture. The visual prognosis is generally good unless the rupture extends through the macular center. Patients need to be followed long-term due to the risk for MNV, as developed in our patient. We elected to closely follow him and will begin anti-VEGF therapy if increasing exudation develops.
