This healthy 17YO male was in a motor vehicle accident 2 weeks earlier. He was not wearing a seat belt and suffered a right upper lid laceration and closed head injury. He noticed immediate vision loss in his right eye. Vision was 20/200 OD and 20/20 in his normal OS.
Color photography shows a large macular and a smaller distal temporal submacular hemorrhage. Multiple choroidal ruptures are visible beneath this blood. OCT scanning shows a central full-thickness macular hole with speckled hyperreflective subretinal material. The submacular blood is hyperreflective with posterior shadowing on either side of the macular hole.
Learning Points:
An acute submacular hemorrhage following blunt trauma always indicates an underlying choroidal rupture as its source. 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.
Since fresh traumatic holes can spontaneously flatten, especially in pediatric cases (Liu et al, AJO 2020;210:174-183), an initial period of observation is recommended before considering vitrectomy. When examined about 6 months following his injury, all blood had resolved, and the temporal foveal choroidal rupture appears to spare the macular center. We will likely recommend vitrectomy if the hole fails to close with several more months of observation.
