This 8YO boy presented with 2 days of vision loss in his left eye following a firecracker injury. Vision was 20/200 OS.
MultiColor SLO imaging shows a blister of foveal fluid with an overlying dot of foveal blood, and more superotemporal subretinal blood. OCT scanning shows foveal subretinal fluid with overlying hyperreflectivity from the blood. Intravenous methylprednisolone was given for 3 days, followed by a short course of oral steroids. One month later, vision improved to 20/60. The fluid and blood resolved with a choroidal rupture now visible temporally.
Learning Points:
An acute submacular hemorrhage following blunt trauma almost always indicates an underlying choroidal rupture as the source of the blood. The final vision is generally good unless the rupture extends through the macular center. These patients need long-term follow-up due to the increased risk of macular neovascularization.
Transient subretinal fluid is an uncommon finding with blunt trauma. Injury to the choroid and RPE allows fluid to accumulate in the subretinal space and outer retina (Mishra et al, Journal of Vitreoretinal Diseases 2021;5:165-169), as likely occurred in our patient.
