Ocular Complications 1 Month After Being Punched

Rachel N. Brackley, OD; Case Series Editor: Jean Marie Pagani, OD


December 17, 2013

Clinical Presentation

A 56-year-old black man presented for a comprehensive eye examination with a chief complaint of flashes and floaters in his right eye. He added that the symptoms began after he received blunt trauma to his right eye a month earlier. His health was remarkable for controlled hypertension.

Examination findings included the following:

  • Best-corrected visual acuity: 20/15 OD and 20/15 OS

  • Pupil testing and extraocular motilities: normal OU

  • Confrontation fields: full OD and OS

  • Slit-lamp examination of the anterior segment: normal OU

  • Intraocular pressures by Goldmann applanation tonometry: 24 mm Hg OD and 17 mm Hg OS

Findings of gonioscopy are shown in Figures 1 and 2.

Figure 1. View of inferior angle using a 4-mirror gonioscopy lens.

Figure 2. View of temporal angle using a 4-mirror gonioscopy lens.

A dilated fundus examination revealed cup-to-disc ratio of 0.30/0.30 with a pink, healthy, and distinct neuroretinal rim OU with clear macula OU. A posterior vitreous detachment was observed in both eyes. The peripheral retina was intact with no retinal holes, tears, or detachments OU.

Additional testing was ordered, including optical coherence tomography (OCT) of the optic nerve head, Humphrey automated visual fields, and optic nerve head photos.


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