Sclopteria Chorioretinitis - Pellet Injury
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This pleasant 16-year-old was seen in the office on 5/26/2009. She was hit in the left eye on Sunday, which is two days ago, with a plastic pellet from a gun that was shot directly at her face. She was seen at St. Petersburg General Hospital where ointment was applied. She notices the vision is still poor. The left eye, for some reason, is amblyopic (I will call you about that further). She did not have strabismus nor did she require surgery.
VISUAL ACUITY: Vision OD is 20/20, OS is 3/200. The right eye is quiet. The left eye has 2+ conjunctival hemorrhage which does look about 5 mm posterior of the corneoscleral limbus at about 8:00 o’clock. I think there is a conjunctival defect, which is self-sealed. The cornea is clear. There is 1+ cell and flare of the anterior chamber. The iris has round and the lenses are clear.
EXTENDED OPHTHALMOSCOPY:
OS: Vertical C/D ratio is 0.2. There is swelling around the optic nerve. The macula looks okay. There is a 2+ vitreous hemorrhage inferonasally. Inferonasally there is a white radial streak of exposed sclera, extending from about the equator back to the edge of the macula at 8:30 o’clock. At the edges of that, the retina is edematous and hemorrhagic. However, I did not see any clear-cut retinal detachment.
ULTRASOUND: The ultrasound confirms there is no retinal detachment.
IMPRESSION:
1. SCLOPETARIA CHORIORETINITIS IN THE LEFT EYE
2. PROBABLE PELLET IN THE LEFT ORBIT
DISCUSSION: I explained to the family that the left eye has an injury but there is no retinal detachment at this moment. There is probably about a 50/50 chance she may develop a retinal detachment there, in which case surgery would be appropriate. At this point though, the risk of surgery is not worth the potential benefit. She does need further testing though to see where the pellet is and I will contact her medical doctor tomorrow. She is fairly confident this was a plastic pellet and, as such, it may not show up on a CT scan and may necessitate MRI scanning. At this point there is no emergency to get that done, but it should be done within the next few days.
She will return here in a week. In the meantime, I put her on Atropine once a day, Pred Forte four times a day, and asked her to return urgently should she notice a striking change in either eye.
CT scan showed plastic pellet in the maxillary sinus.
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Sclopteria Chorioretinitis - 16 Year Old Girl - Pellet Injury723 views
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Sclopteria Chorioretinitis - 16 Year Old Girl - Pellet Injury750 views
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Sclopteria Chorioretinitis - 16 Year Old Girl - Pellet Injury623 views
(0 votes)
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Sclopteria Chorioretinitis - 16 Year Old Girl - Pellet Injury656 views
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Sclopteria Chorioretinitis - 16 Year Old Girl - Pellet Injury611 views
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Sclopteria Chorioretinitis - 16 Year Old Girl - Pellet Injury578 views
(0 votes)
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This pleasant 16-year-old was seen in the office on 5/26/2009. She was hit in the left eye on Sunday, which is two days ago, with a plastic pellet from a gun that was shot directly at her face. She was seen at St. Petersburg General Hospital where ointment was applied. She notices the vision is still poor. The left eye, for some reason, is amblyopic (I will call you about that further). She did not have strabismus nor did she require surgery.
VISUAL ACUITY: Vision OD is 20/20, OS is 3/200. The right eye is quiet. The left eye has 2+ conjunctival hemorrhage which does look about 5 mm posterior of the corneoscleral limbus at about 8:00 o’clock. I think there is a conjunctival defect, which is self-sealed. The cornea is clear. There is 1+ cell and flare of the anterior chamber. The iris has round and the lenses are clear.
EXTENDED OPHTHALMOSCOPY:
OS: Vertical C/D ratio is 0.2. There is swelling around the optic nerve. The macula looks okay. There is a 2+ vitreous hemorrhage inferonasally. Inferonasally there is a white radial streak of exposed sclera, extending from about the equator back to the edge of the macula at 8:30 o’clock. At the edges of that, the retina is edematous and hemorrhagic. However, I did not see any clear-cut retinal detachment.
ULTRASOUND: The ultrasound confirms there is no retinal detachment.
IMPRESSION:
1. SCLOPETARIA CHORIORETINITIS IN THE LEFT EYE
2. PROBABLE PELLET IN THE LEFT ORBIT
DISCUSSION: I explained to the family that the left eye has an injury but there is no retinal detachment at this moment. There is probably about a 50/50 chance she may develop a retinal detachment there, in which case surgery would be appropriate. At this point though, the risk of surgery is not worth the potential benefit. She does need further testing though to see where the pellet is and I will contact her medical doctor tomorrow. She is fairly confident this was a plastic pellet and, as such, it may not show up on a CT scan and may necessitate MRI scanning. At this point there is no emergency to get that done, but it should be done within the next few days.
She will return here in a week. In the meantime, I put her on Atropine once a day, Pred Forte four times a day, and asked her to return urgently should she notice a striking change in either eye.
CT scan showed plastic pellet in the maxillary sinus.
