An Airbag Deploys, Leaving Vision Blurry and Distorted Despite Treatment

Ronald C. Gentile, MD; Jessica Lee, MD

Disclosures

February 26, 2016

Clinical Presentation

A 53-year-old man was involved in a motor vehicle accident 3 weeks ago, during which he sustained blunt trauma to the right side of his face and eye by a deployed airbag.

He was initially treated in the emergency department for a corneal abrasion, traumatic iritis, microhyphema, neck strain, and superficial friction burns to the right side of his face. Intraocular pressure was reported as lower in the right eye than the left eye. There was no evidence of any chemical exposure on initial presentation, and no eyewear was being worn at the time of the collision.

The patient felt that even though his vision improved as the corneal abrasion healed, it remained very blurry and distorted.

Current medications included a topical corticosteroid and a cycloplegic agent twice a day. Cycloplegic refraction obtained 1 year earlier was +0.50 in both eyes.

Visual acuity was 20/150- in the right eye and 20/20 in the left eye without correction. Manifest refraction was able to improve his visual acuity in the right eye to 20/50 with a +2.25 -0.25 at 85. Color vision using Ishihara plates was 6/6 in both eyes. Amsler grid revealed distortion in the right eye and was within normal limits in the left eye. There was anisocoria with a minimally reactive 7-mm pupil in the right eye and a normally reactive 3-mm pupil in the left eye, without a relative afferent pupillary defect.

Anterior segment examination of the right eye demonstrated iris sphincter tears localized temporally and nasally, phacodonesis, and a traumatic cataract. The anterior chamber depth in the right eye was slightly shallower compared with the left eye, with rare cell and +1 flare. Anterior segment examination of the left eye was normal. Intraocular pressures using applanation tonometry were 4 mm Hg in the right eye and 12 mm Hg in the left eye. Gonioscopic examination of the right eye demonstrated an open angle with ciliary body band abnormalities inferior nasally (Figure 1).

Figure 1. Gonioscopy of the right eye, showing an open angle with an abnormal area at the 5 o'clock position (white arrow) posterior to the scleral spur line (black arrow).

Funduscopic examination demonstrated cup-to-disc ratios of 0.05 in the right eye and 0.1 in the left eye. In the right eye, there were radiating folds in the macula (Figure 2), with low-lying peripheral retinal elevations but no retinal holes or tears. The retina in the left eye was normal (Figure 3).

Figure 2. Funduscopic photograph of the right eye, revealing radiating macular folds with tortuous vessels and edema of the optic disc.

Figure 3. Funduscopic photograph of the left eye, revealing a normal appearance of the retina.

Optical coherence tomography of the macula revealed undulation of the retina and choroid (Figure 4).

Figure 4. Optical coherence tomography horizontal scan of the right eye with corresponding false fundus image, revealing undulation of the retina and choroid.

Ultrasound biomicroscopy (UBM) of the right eye demonstrated abnormalities of the ciliary body insertion at the 5 o'clock position, with echolucent ciliochoroidal fluid (Figure 5).

B-scan ultrasonography of the right eye had choroidal thickening with peripheral annular elevation in all four quadrants.

Figure 5. Ultrasound biomicroscopy of the right eye, revealing an abnormal insertion of the ciliary body at the 5 o'clock position with ciliochoroidal effusion.

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