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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 27

Traumatic macular tear


1 Department of Vitreoretinal, Moorfields Eye Hospital NHS Foundation Trust, London, England, UK
2 Department of Ophthalmology, Florida Hospital, Santiago, Chile

Date of Submission07-Jul-2020
Date of Acceptance30-Jul-2020
Date of Web Publication18-Sep-2020

Correspondence Address:
Dr. Rodrigo Anguita
Moorfields Eye Hospital, City Road, London EC1V 2PD
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PAJO.PAJO_34_20

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  Abstract 


The purpose is to report a case of horseshoe macular tear and its management. Case reports of a patient with blunt trauma including findings on clinical examination, color fundus photography, and spectral-domain optical coherence tomography (OCT). A 23-year-old presented with a blunt ocular trauma from a plastic toy in the right eye. Fundoscopy revealed a horseshoe macular tear associated with a partial posterior vitreous detachment (PVD). OCT confirmed a full thickness macular tear with radial extension and associated retinal thickening. The patient underwent conservative management and was followed closely showing a spontaneous resolution of the macular tear. Our case report describes an example of traumatic horseshoe macular tear; we hypothesized that the PVD and the secondary inflammation as a result of the trauma were responsible for the spontaneous resolution of macular tear in our case.

Keywords: Blunt trauma, horseshoe macular tear, ocular trauma, optical coherence tomography, traumatic macular hole


How to cite this article:
Anguita R, Roth J, Katta M, Nazar C. Traumatic macular tear. Pan Am J Ophthalmol 2020;2:27

How to cite this URL:
Anguita R, Roth J, Katta M, Nazar C. Traumatic macular tear. Pan Am J Ophthalmol [serial online] 2020 [cited 2020 Oct 21];2:27. Available from: https://www.thepajo.org/text.asp?2020/2/1/27/295338




  Introduction Top


The association between blunt ocular trauma and macular complications such as commotio retinae, traumatic macular hole, choroidal rupture, preretinal and subretinal hemorrhages, and peripheral retinal tears and dialysis is well known. However, a horseshoe tear at the macula following blunt trauma is a rare clinical presentation.[1],[2]

In this article, the authors report a case of traumatic macular tear following blunt trauma with a spontaneous resolution after 1 week.


  Case Report Top


A 23-year-old woman presented with a blunt ocular trauma from a plastic toy in the right eye (RE). On examination, visual acuity (VA) was counting fingers in RE and 20/20 in the left eye. Anterior segment examination showed evidence of traumatic uveitis. Intraocular pressure and gonioscopy were within normal limits. Dilated retinal examination revealed a horseshoe macular tear associated with commotio retinae and retinal hemorrhages [Figure 1]a and [Figure 1]b with a partial posterior vitreous detachment (PVD). Spectral-domain optical coherence tomography (OCT) [Figure 1]c and [Figure 1]d confirmed a full thickness macular tear with radial extension and retinal thickening. Conservative management was opted for and the patient was followed closely. After 1 week, on clinical examination and OCT, a spontaneous closure was observed. One month after the injury, the VA was 20/320 in RE. Fundoscopy showed evidence of traumatic pigment epitheliopathy and gliosis of posterior pole with PVD [Figure 1]e OCT [Figure 1]f revealed a complete loss of the normal segmentation of the retina with subfoveal gliosis.
Figure 1: (a and b) Fundus picture and red free image showing a horseshoe macular tear associated with commotio retinae and retinal hemorrhages. (c and d) Spectral-domain optical coherence tomography revealed a full thickness macular tear with radial extension and retinal thickening. (e) fundus picture showing traumatic pigment epitheliopathy and gliosis of posterior pole. (f) Spectral-domain optical coherence tomography showing complete loss of normal segmentation of retina with subfoveal gliosis

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  Discussion Top


The exact mechanism for the formation of a traumatic macular hole is unclear, however, it has been hypothesized that a sudden compression and expansion of the eye after a blunt trauma produces tractional stress on the retina exactly at the point of vitreous attachment. A centrifugal force acting equally in all directions exerted by the posterior vitreous over the macula owing to the coup-contrecoup mechanism causes traumatic macular holes. However, if vitreous attachment is not equal at all sides of macula, the sudden traction exerted on the macula could result in a macular tear, instead of a hole.[1],[3]

Horseshoes macular tears are extremely rare and these have been reported in association with ocular trauma, branch retinal vein occlusion,[4] and idiopathic.[5]

The treatment of macular tears has not been established. While some authors recommend a conservative management in young patients with a small hole or tear, associated vitreous hemorrhage and subretinal hemorrhage could be indications for surgical treatment. Karaca et al.[1] reported spontaneous closure after a traumatic macular tear while other authors[4],[5] have reported variable results in patients who underwent vitrectomy and gas. We believe the management of this condition should be based on the clinical examination and OCT features of each patient. We hypothesize that the PVD and the secondary inflammation as a result of the trauma can be responsible for the spontaneous resolution of the macular tear in our case, which trigger glial and retinal pigment epithelial cell proliferation and also the release of traction after a PVD. The main reason for poor visual outcomes after a macular tear closure is the glial proliferation and traumatic pigment epitheliopathy causing photoreceptor cell damage.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Karaca U, Durukan HA, Mumcuoglu T, Erdurman C, Hurmeric V. An unusual complication of blunt ocular trauma: A horseshoe-shaped macular tear with spontaneous closure. Indian J Ophthalmol 2014;62:501-3.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Bouziani Y, Benhhadou R, Ballyout S, El Kholti Y, Jellab B, Hajji I, et al. Traumatic macular tear. J Fr Ophtalmol 2013;36:613.  Back to cited text no. 2
    
3.
Madanagopalan VG, Thotakura M, Dhoble P. Macular horseshoe-shaped tear following cricket injury. JAMA Ophthalmol 2017;135:e173855.  Back to cited text no. 3
    
4.
Karim-Zade K, Bilgic A, Bartz-Schmidt KU, Gelisken F. Horseshoe-like macular tear following recurrent branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2007;245:1221-3.  Back to cited text no. 4
    
5.
Kubota M, Shibata T, Gunji H, Tsuneoka H. Idiopathic horseshoe-like macular tear: A case report. Int Med Case Rep J 2016;9:219-22.  Back to cited text no. 5
    


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