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Ординатура / Офтальмология / Учебные материалы / Ocular Traumatology Springer

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524 Wolfgang Schrader and Ferenc Kuhn

3.3.3.7Valsalva Retinopathy

A rapid rise in abdominal pressure, especially against a closed glottis, is called a Valsalva maneuver. It may occur during heavy lifting, coughing, vomiting, blowing balloons, or other straining activities. As the veins above the heart have no valves, a Valsalva maneuver induces a rapid rise in the intravenous pressure and may cause a rupture of the superficial retinal or conjunctival capillaries and a hemorrhagic retinopathy. Underlying conditions, such as diabetic retinopathy, retinal telangiectasis, arterial macroaneurysms, pregnancy, and sickle cell disease, may exacerbate the development of a hemorrhage, as does anticoagulant therapy.

3.3.3.7.1 Evaluation

A history of straining can usually be identified. The amount of visual impairment depends on the extent of the foveal hemorrhage.

On slit lamp, the anterior segment is mostly normal, although subconjunctival hemorrhage may be present.

On ophthalmoscopy, retinal hemorrhages are seen, including subhyaloidal bleeding and the typical hemorrhagic macular cyst underneath the ILM [6]. A meniscus may be observed as the blood settles inferiorly. Vitreous hemorrhage may also develop if the blood breaks through.

3.3.3.7.2 Treatment

The preretinal/sub-ILM hemorrhage usually clears spontaneously. If the hemorrhage does not resolve within a few weeks, it can be drained with a pulsed YAG-laser [23]. Vitrectomy is often necessary (see Chap. 2.9).

3.3.3.8Whiplash Syndrome

Whiplash injury occurs via an acceleration−deceleration energy transfer to the neck.10 It is most often seen in a person involved in rear-end or side-im- pact MVC. The bone and soft tissue trauma (whiplash injury) in turn may lead to a variety of clinical manifestations (whiplash-associated disorders).

10 Violent flexion that is followed immediately by an extension of the neck.

  3.3  The Effects of Systemic Trauma on the Eye

525

The visual disturbance may be caused by the sequealae of a direct injury to the cervical or carotid artery, or by an accompanying Purtscher type of trauma (see above).

3.3.3.8.1 Symptoms

The complains include the following:

•Mild to severe neck pain (88−100%) and headache (54−66%) [26].

•Mild reduction in visual acuity11 (8−26%; [1, 26]), which presents acutely. The symptoms are bilateral and resolve over a period of a few days.

•Horner’s syndrome (miosis, ptosis, and pseudo-endophthalmitis) [3].

3.3.3.8.2 Evaluation

On external inspection, temporary palsy of cranial nerves with diplopia may be found if the brain has suffered a concussion [3]. On ophthalmoscopy, a grayish swelling of the foveal area is seen right after the injury. A crater-like depression of less than 100 µm in diameter with slight RPE disturbance develops and can remain unchanged even if the patient’s visual symptoms have improved [13]. On the FLAG, a small area of hyperfluorescence may be observed [13].

3.3.3.8.3 Management

There is no known treatment. The visual acuity usually returns to 20/20, although it can also remain diminished. The clinical appearance and course may be similar to those of contusion retinopathy or solar retinopathy [6]. The findings should be precisely documented and photographed because the patient may later seek compensation for the injury (see Chap. 1.8).

11 Usually ~20/30.

DO:

•carefully examine the child if foul play is suspected

•weigh all options, consider the benefits and risks, when deciding whether or not to intervene for a vitreous or macular hemorrhage caused by bodily trauma

DON’T:

•refuse vitrectomy just because the prognosis is “generally poor”: surgery can nevertheless be beneficial to the particular individual

Summary

A variety of ocular sequelae can be caused by injuries to the body. The ocular consequences may be inconsequential but can also be severe, and

the bodily trauma can be fatal in an abused infant. For many of the ocular complications there is no known treatment.

References

[1]Burke JP, Orton HP, West J, Strachan IM, Hockey MS, Ferguson DG (1992) Whiplash and its effect on the visual system. Graefe’s Arch Clin Exp Ophthalmol 230: 335−339

[2]Duke-Elder S, Leigh AG (1965) System of ophthalmology, vol VIII: Diseases of the outer eye. Mosby, St. Louis, pp 995−1003

[3]Duke-Elder S, MacFaul P (1972) System of ophthalmology. Injuries, part I: Mechanical injuries, vol XIV. Henry Klimpton, London

[4]Frizzel R, Kuhn F, Morris R, Quinn C, Fisher W (1997) Screening for ocular hemorrhages in patients with ruptured cerebral aneurysms: a prospective study on 99 patients. Neurosurgery 41: 529−534

[5]Garfinkle AM, Danys IR, Nicolle DA, Colohan AR, Brem S (1992) Terson’s syndrome: a reversible cause of blindness following subarachnoid hemorrhage. J Neurosurg 76: 766−771

[6]Gass J (1987) Stereoscopic atlas of macular disease: diagnosis and treatment. Mosby, St. Louis

[7]Greenwald MJ, Weiss A, Oesterle CS, Friendly DS (1986) Traumatic retinoschisis in battered babies. Ophthalmology 93: 618−625

  3.3  The Effects of Systemic Trauma on the Eye

527

[8]Han DP, Wilkinson WS (1990) Late ophthalmic manifestations of the shaken baby syndrome. J Pediatr Ophthalmol Strabismus 27: 299−303

[9]Harley RD (1980) Ocular manifestations of child abuse. J Pediatr Ophthalmol Strabismus 17: 5−13

[10]Hayreh SS (1987) Anterior ischemic optic neuropathy. VIII. Clinical features and pathogenesis of post-hemorrhagic amaurosis. Ophthalmology 94: 1488−1502

[11]Hollenhorst RW, Stein HA (1958) Ocular signs and prognosis in subdural and subarachnoid bleeding in young children. AMA Arch Ophthalmol 60: 187−192

[12]Johnson MW, Kincaid MC, Trobe JD (1987) Bilateral retrobulbar optic nerve infarctions after blood loss and hypotension. A clinicopathologic case study. Ophthalmo­ logy 94: 1577−1584

[13]Kelley JS, Hoover RE, George T (1978) Whiplash maculopathy. Arch Ophthalmol 96: 834−835

[14]Kuhn F, Morris R, Mester V, Witherspoon C (1998) Terson’s syndrome. Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. Ophthalmology 105: 472−477

[15]Lambert SR, Johnson TE, Hoyt CS (1986) Optic nerve sheath and retinal hemorrhages associated with the shaken baby syndrome. Arch Ophthalmol 104: 1509−1512

[16]Lancon JA, Haines DE, Parent AD (1998) Anatomy of the shaken baby syndrome. Anat Rec 253: 13−18

[17]Levin AV (1991) Ocular complications of head trauma in children. Pediatr Emerg Care 7: 129−130

[18]Levin DB, Bell DK (1977) Traumatic retinal hemorrhages with angioid streaks. Arch Ophthalmol 95: 1072−1073

[19]Ludwig S, Warman M (1984) Shaken baby syndrome: a review of 20 cases. Ann Emerg Med 13: 104−107

[20]McFadden DM, Houston CS, Sutton JR, Powles AC, Gray GW, Roberts RS (1981) High-altitude retinopathy. J Am Med Assoc 245: 581−586

[21]Mushin AS (1971) Ocular damage in the battered-baby syndrome. Br Med J 3: 402−404

[22]Rao N, Smith RE, Choi JH, Xu XH, Kornblum RN (1988) Autopsy findings in the eyes of fourteen fatally abused children. Forensic Sci Int 39: 293−299

[23]Raymond LA (1995) Neodymium:YAG laser treatment for hemorrhages under the internal limiting membrane and posterior hyaloid face in the macula. Ophthalmo­ logy 102: 406−411

[24]Riffenburgh RS, Sathyavagiswaran L (1991) Ocular findings at autopsy of child abuse victims. Ophthalmology 98: 1519−1524

[25]Schultz PN, Sobol WM, Weingeist TA (1991) Long-term visual outcome in Terson syndrome. Ophthalmology 98: 1814−1819

528 Wolfgang Schrader and Ferenc Kuhn

[26]Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, Zeiss E (1995) Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine 20: 1S−73S

[27]Teichmann KD, Gronemeyer U (1981) Unilateral morbus Purtscher with poor visual outcome. Ann Ophthalmol 13: 1295−1299

[28]Velikay M, Datlinger P, Stolba U, Wedrich A, Binder S, Hausmann N (1994) Retinal detachment with severe proliferative vitreoretinopathy in Terson syndrome. Ophthalmology 101: 35−37

[29]Wilkinson WS, Han DP, Rappley MD, Owings CL (1989) Retinal hemorrhage predicts neurological injury in the shaken baby syndrome. Arch Ophthalmol 107: 1472−1474

[30]Williams DF, Mieler WF, Williams GA (1990) Posterior segment manifestations of ocular trauma. Retina 10: S35−S44

[31]Wygnanski-Jaffe T, Levin AV, Shafiq A, Smith C, Enzenauer RW, Elder JE, Morin JD, Stephens D, Atenafu E (2006) Postmortem orbital findings in shaken baby syndrome. Am J Ophthalmol 142: 233−240

      Subject Index

A

 

 

 

 

AC depth 

210, 211, 235, 245

AC irrigation 

217

 

AC lavage 

456

 

AC maintainer 

220, 221, 253

air 

202, 216, 261, 275, 288, 320,

482

 

 

 

– in AC 

221

 

 

alpha-chymotrypsin 

203, 258

amblyopia 

428

 

aminocaproic acid 

215

anesthesia

 

 

 

–general  93

–local  94

–peribulbar  95 aniridia  237, 360 anterior segment

reconstruction  227, 228

antibiotics  132, 134, 135, 143, 157, 161, 163, 447, 448

APD  113, 137

– in the OTS  20

aqueous  154, 173, 199, 210, 211, 269, 272, 323, 455, 457, 458, 465, 466, 467

autologous serum  158

B

blind, painful eye

–management of  92

–retrobulbar injection for  92 blood loss-related trauma  514 bucket handle sign  283 bungee cord  62

C

capsular tension ring  251, 262 cataract  205, 249, 256, 261, 379,

424, 465

–management algorythm of  261 champagne bottle corks  57 chemical injury  130, 487

–grading in  490

–history-taking in  488

–lid reconstruction in  495 chemosis  144

chorioretinitis sclopetaria  294, 340

choroidal rupture  276, 342 choroid prolapse  203 ciliary body

–prolapse  203

–scarring  272

530 Subject Index

–shutdown  338

–suturing  271 color vision  110 conjunctiva

–eversion of upper tarsal  141 conjunctival

–dissection  147

–emphysema  144

–erosion  143

–FB  145

–hemorrhage  144

–ischemia  149

–necrosis  149

–wound  146

contact lens

– bandage soft  157, 162 contusion  7, 161, 276, 282, 335,

341, 348, 425, 452

contusion retinopathy  294, 340, 383, 520

cornea

–debridement of  131

–irrigation of  130 corneal

–blood staining  213, 218

–edema  161, 163, 311, 440

–erosion  131, 156

–debridement of  158

–recurrent  158

–FB  159

–micropuncture  159

–resistance

–postsurgical  153

–scar

–management of  181

–scar information  151

–suture

–removal of  181

–wound

–partial-thickness  161

–self-sealing  161

–suturing of  163

–wound healing  152

corticosteroids  132, 157, 163, 214, 242, 447

couching

– giving up on the eye  31 counseling  101

–benefits of  29

–coaching  31

–

elements of 

23, 24, 26, 27

–

goal of 

25

 

cryopexy 

271, 299, 306, 458

–

prophylactic 

325

CT  121, 124, 186, 519

cyclodialysis 

270, 338

cycloplegics 

132, 157, 214, 243

D

Dalen−Fuchs nodules  91 deep lamellar endothelial

keratoplasty  161 diathermy  271 documentation  126 DSAEK  161

E

EAV  272, 406, 446, 475

ECCE  252, 382

ECH  84, 131, 210, 273

Subject Index

531

edema

–optic disc  91

–retinal  91 EEM  37, 38, 380

elderly patients’ injuries  428 EMP  508

empathy  26 EMP mangement

–algorythm of  313 endolaser cerclage  324 endophthalmitis  133

–diagnostics  440, 443

–during general anesthesia  94

–in the OTS  20

–management principles  437

–prophylaxis  448

–retinopathy  442

–risk factors for  439 endoscope  126, 269, 407 endoscopy  218, 475

–surgical technique  479

–technology  473 enophthalmos  114 enucleation  90, 92

–traumatic  9

epidemiology

–age  54

–gender  54

–intent  59, 60

–place  56

–race  55

–socioeconomic status  54

–source  57

ERG  111 evaluation

–ophthalmic  106

–systemic  106 evisceration  90, 92 exophthalmos  114 explosion  83, 107 external inspection  113

extraocular muscle  121, 191 eye

–as surprise package  81

–protection  66

–shield  88

–wall  7

F

fall  54, 58, 428, 429, 451 fibrinous membrane  219

FILMS 

302

 

firearms 

61

 

fireworks 

65

 

FLAG 

503, 505, 514, 517, 525

flap in

 

 

 

– corneal wound 

162

fluid-air exchange 

311, 316, 319,

323

 

 

 

fluorescein  115, 154 foreign body sensation  156

G glaucoma

–and angle recession  455

–due to chemical trauma  459

–due to epithelial downgrowth  458

–due to fibrous ingrowth  458

–due to lens luxation  456

532 Subject Index

–

due to lens subluxation  456

–

due to lens swelling  454

–due to orbital hypertension  459

–due to synechiae  458

–ghost Cell  456

–hemolytic  455

–hemosiderotic  455

–in contusion  452

–in hyphema  454

–in open globe injury  457

–malignant  210, 457

–phacoanaphylactic  457

–phacolytic  456

glue  162

H

hammering  65, 107 hemorrhagic macular cyst  522,

524

high-altitude retinopathy  515 history  107, 108

Horner’s syndrome  525 hyperbaric trauma  515 hyphema  211, 337

–classification  214

–posterior segment pathology

in  212 hypopyon  133 hypotony

–due to choroidal detachment  467

–due to ciliary body destruction  468

– due to ciliary body shock  467

–due to ciliochoroidal detachment  466

–due to inflammation  467

–due to retinectomy  467

– due to wound Leak  466

I

ICCE  252, 382

ILM  298, 309, 522

–staining of  300 injury

–at home  56

–at workplace  56

–classification

–grade  14, 15

–pupil  14, 15

–type  14, 15

–zone  14, 15

–closed globe  7

–database  101

–www.useironline.org  21, 53

–www.weironline.org  21, 54

–laceration  8

–mixed  7

– myths  40, 41, 42, 43, 44, 45

–open globe  7

–penetrating  8

–perforating  8

–perforating, in the OTS  20

–prognostic information  18, 19

–

truths  40, 41, 42, 43, 44, 45

injury to entire globe

–

management options in  406

Subject Index

533

intrascleral FB  186 IOFB  8, 187

–deep-impact  383

–deep impact  386

–evaluation for  371

–in AC  373

–in vitreous  382

–management algorythm in  374

–management issues in  376

–removal instrumentation  380, 387

–retinal  384

–subretinal  384

IOL

–implantation  262

–luxation of  263

–subluxation  263

–surface management of  313 IOM  160, 380

IOP  134, 337

–control during vitrectomy  400

–evaluation of  113

–in general anestthesia  93

–in hyphema  218

–in retinal prolapse  206 iridodialysis  236, 337 iris

–bombans  211, 227, 454, 456, 458

–excision  202, 203

–laceration

– surgery for  235

–prolapse  201

–reposition  202

iritis  242

IR light  502, 506 irrigation  489, 491

K

 

 

 

kissing choroidals 

275

L

 

 

 

lacrimation 

156

 

 

lamellar keratoplasty  496

lamellar laceration 

7

laser-induced eye injury  505

– prevention of 

506

laser pointers 

508

 

laser retinopexy 

306, 325, 341,

383

 

 

 

–prophylactic  324 lens

–capsular rupture  255, 337

– dislocation  210, 211, 220, 249

–extrusion  203

–feathering  315

–injury

– classification of  246

–luxation of  253, 338

–subluxation of  251, 338

–swelling  210

–touch  261

lensectomy  252, 254, 258, 382, 424, 482

lid

– double eversion of  492 lightning-induced trauma  509 light sensitivity  91

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