Pistol to Temple - Shockwave Retinal Damage
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66-year-old woman was seen in the office on 11/24/2010. She had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temporal, toward the lower part of the temporal and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. She did have a post discharge seizure, which was brief and she had low blood pressure at the time. She had bruising of both lids. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. Because of the macular irregularities, she suggested she come here for an evaluation as well.
VISUAL ACUITY: OD light perception, OS 20/400. IOP: OD 11, OS 12.
SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. There is 1+ pallor to the optic nerve. There is posterior vitreous separation. There are pigment epithelial irregularities in the macula.
OS: Vertical C/D ratio is 0.6. There is posterior vitreous separation. There are pigment irregularities in the macula.
OCT SCAN: The OCT scan shows retinal atrophy in both eyes, predominately of the inner retina with full thickness retinal atrophy centrally. The average central thickness in the right eye is 122 microns, the left eye 80 microns.
NERVE FIBER LAYER SCANS: Also show nerve fiber layer atrophy in each eye with the thickness in the right eye being 46 microns and the left eye 77 microns.
Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: Shows the irregular macula hyperfluorescence in each eye from the nongeographic central pigment epithelial atrophy. There is no evidence of any leakage or fluid.
IMPRESSION:
1. ISCHEMIC RETINOPATHY – BOTH EYES
2. CENTRAL RETINAL ARTERY OCCLUSION – BOTH EYES
3. PROBABLE OPHTHALMIC ARTERY OCCLUSION – RIGHT EYE
4. POSSIBLE TRAUMATIC OPTIC NEUROPATHY
DISCUSSION: I explained to the patient that the predominate findings on the testing today is extremely thin retinas, both in the macula and the periphery as well as nerve fiber layer atrophy. This is consistent with either traumatic injury causing traumatic optic neuropathy, but I think probably given the rapidity of the vision loss, this may very well have been from an ischemic event. Either way at this point unfortunately I do not have anything to do for her eyes. I explained to her there is no treatment. We have to either replace or resurrect damaged retina. I suggested however, she return for a check in six months. I asked her to see you back regularly. I gave her recommendations for low vision evaluations as well as counseling that might be helpful to her adapting to her current vision state.
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vu 567 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. 
(1 votes)
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vu 468 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. 
(0 votes)
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vu 462 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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vu 492 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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vu 498 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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vu 512 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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vu 430 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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vu 513 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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vu 565 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 477 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 515 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(1 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 423 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 397 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 501 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(1 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 414 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 479 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 413 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 418 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 399 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 395 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 408 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 434 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 405 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 390 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 555 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 462 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 422 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 461 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 437 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 418 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400vu 444 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide - Retinal Atrophy - Shockwave Retinopathy vu 505 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide - Retinal Atrophy - Shockwave Retinopathy vu 584 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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Pistol to head in attempted suicide - Retinal Atrophy - Shockwave Retinopathy vu 642 fois66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400.
(0 votes)
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66-year-old woman was seen in the office on 11/24/2010. She had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temporal, toward the lower part of the temporal and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. She did have a post discharge seizure, which was brief and she had low blood pressure at the time. She had bruising of both lids. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. Because of the macular irregularities, she suggested she come here for an evaluation as well.
VISUAL ACUITY: OD light perception, OS 20/400. IOP: OD 11, OS 12.
SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. There is 1+ pallor to the optic nerve. There is posterior vitreous separation. There are pigment epithelial irregularities in the macula.
OS: Vertical C/D ratio is 0.6. There is posterior vitreous separation. There are pigment irregularities in the macula.
OCT SCAN: The OCT scan shows retinal atrophy in both eyes, predominately of the inner retina with full thickness retinal atrophy centrally. The average central thickness in the right eye is 122 microns, the left eye 80 microns.
NERVE FIBER LAYER SCANS: Also show nerve fiber layer atrophy in each eye with the thickness in the right eye being 46 microns and the left eye 77 microns.
Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: Shows the irregular macula hyperfluorescence in each eye from the nongeographic central pigment epithelial atrophy. There is no evidence of any leakage or fluid.
IMPRESSION:
1. ISCHEMIC RETINOPATHY – BOTH EYES
2. CENTRAL RETINAL ARTERY OCCLUSION – BOTH EYES
3. PROBABLE OPHTHALMIC ARTERY OCCLUSION – RIGHT EYE
4. POSSIBLE TRAUMATIC OPTIC NEUROPATHY
DISCUSSION: I explained to the patient that the predominate findings on the testing today is extremely thin retinas, both in the macula and the periphery as well as nerve fiber layer atrophy. This is consistent with either traumatic injury causing traumatic optic neuropathy, but I think probably given the rapidity of the vision loss, this may very well have been from an ischemic event. Either way at this point unfortunately I do not have anything to do for her eyes. I explained to her there is no treatment. We have to either replace or resurrect damaged retina. I suggested however, she return for a check in six months. I asked her to see you back regularly. I gave her recommendations for low vision evaluations as well as counseling that might be helpful to her adapting to her current vision state.
