Central Retinal Artery Occlusion After Contusive Ocular Trauma

Contusive eye trauma can lead to damage to different ocular structures. However, vascular occlusions following this type of trauma remain uncommon. We report the case of central retinal artery occlusion (CRAO) in a healthy 33-year-old patient following contusive ocular trauma of the left eye.

Introduction

Contusive ocular trauma is a closed globe trauma that can compromise the visual prognosis of the traumatized eye [1]. This type of trauma constitutes a frequent reason for consultations in ophthalmological emergencies. It can cause isolated or associated lesions of several structures of the globe [2]. However, ocular contusions rarely lead to retinal vascular occlusions [3].

Case Report

We report the case of central retinal artery occlusion (CRAO) in a healthy 33-year-old patient who presented to the ophthalmological emergency room for immediate reduced visual acuity following left ocular trauma following contusive trauma from an iron bar during an altercation.

Visual acuity was the perception of light. Ophthalmological examination revealed eyelid ecchymosis and no anterior segment abnormality. Intraocular pressure was 11 mmHg. Fundus examination revealed retinal oedema with a cherry red spot at the macula. The next day, the retinal oedema was more apparent with the disappearance of the cherry red spot, which was probably hidden by swelling in the macular area (Fig. 1).

Fig. 1. One day after the trauma, left eye shows retinal edema with swelling in the macular area.

Retinal angiography was also in favour of CRAO (Fig. 2). Macular OCT also revealed macular oedema with thickening of the inner and outer layers of the retina and disorganization of the retinal layers (Fig. 3). Orbital cranial CT and MRI did not reveal any lesions that could be the cause of CRAO.

Fig. 2. One day after the trauma, early stage of retinal fluorescein angiography of the left eye showed occlusion of the central retinal artery with capillary non-perfusion.

Fig. 3. One day after the trauma, macular OCT of the left eye showed macular edema with thickening of the inner and outer layers of the in the macular area.

Discussion

Spontaneous CRAO is the prerogative of elderly subjects. Atherosclerosis and emboli are the most likely cause of ischemia. Occlusions are uncommon but can follow certain surgical procedures on the eyeball, eyelids or nose. They would result from an arterial spasm with poorly understood trigger mechanisms [3]. However, this disease is rare in young people and requires a broad etiological assessment [4]. Several physiopathological hypotheses of traumatic CRAO exist in the literature: elevation of intraocular pressure, mechanical stress or injury to the optic nerve [5]. Isolated cases of traumatic CRAO were initially reported in patients with hemoglobinopathy [6] and systemic lupus erythematosus [7]. In the literature, a few cases of CRAO following contusive ocular trauma have been described. Two cases of mixed occlusion of the central artery and central vein of the retina were described following contusive trauma by a football in a young man with no particular history [8] and in a healthy young woman following blunt trauma [9]. Some authors described isolated CRAO cases [5], while others have reported cases associated with traumatic optic neuropathy [10] and commotio-retinas [4]. The mechanism is not always identified. The duration and degree of the loss of visual acuity vary greatly [5]. Although cases of retinal vascular occlusion are rare in the literature, clinicians need to keep this complication in mind.

Conclusion

Central retinal artery occlusion is a possible complication of contusive eye trauma, although it is less common.