Definition

Commotio retinae refers to retinal damage (retinopathy) caused by direct or indirect injury to the eyeball. This condition can result from direct eye injury or impact elsewhere that affects the retina. The retinal color may change to a grayish-white due to damage to the photoreceptors, which are responsible for capturing images. This damage can impair vision and alter the retinal color from orange to grayish-white. An ophthalmologist can detect these changes using an ophthalmoscope or slit lamp.

Commotio retinae affecting the back of the retina is known as Berlin's edema. This condition occurs in approximately 30% of eye trauma cases seen in hospitals and is more prevalent in young men.

Causes

Blunt force trauma to the forepart of the eye can displace the lens and iris diaphragm, pushing them towards the edge and outward. Indirect impacts can transmit vibrations to the eyeball, causing similar effects on the lens and iris, leading to ocular tissue tears. The retina, a non-elastic layer, is highly susceptible to damage from such vibrations. While blood flow to the retina typically remains unaffected, blood flow to other layers, such as the choroid, may be disrupted.

Sudden vibrations and pressure from injury or impact cause retinal swelling that can affect the macular area, which is central to vision. Vision may improve if the swelling subsides without damage to the retinal pigment epithelium (RPE). However, damage to the photoreceptor cells can lead to persistent commotio retinae.

Risk Factor

Risk factors for commotio retinae include high-impact activities, such as sports involving balls, violence, motorcycle accidents, and occupational activities that increase the risk of facial and eye trauma.

Symptoms

• Sudden blurred vision following an injury
• Sudden partial loss of vision following an injury
• Sudden total loss of vision following an injury

Diagnosis

Your doctor will inquire about the injury mechanism that led to your visual impairment and perform an examination using an ophthalmoscope or slit lamp to observe your retina. A paler retina, with or without bleeding, may be visible within hours after the injury. Further diagnostic tests include:

• Optical Coherence Tomography (OCT): This test examines the condition of the retinal layers and helps in establishing a diagnosis.
• Fundus Fluorescein Angiography (FFA): This test detects early blockages in the retinal blood vessels using a contrast agent to clearly visualize the vessels.

Differentiation of commotio retinae from other conditions such as retinal artery occlusion, retinal detachment, traumatic macular hole, and choroidal rupture is necessary.

Management

There is no specific treatment for commotio retinae. Patients require close monitoring for several days to weeks after the injury to check for complications. If the condition does not improve, anti-inflammatory drug injections into the eyeball may reduce swelling and improve vision.

Complications

Retinal commotion generally resolves on its own, but severe trauma can cause visual disturbances like paracentral scotoma. In some cases, improvement occurs within four weeks after the injury, but evaluation and monitoring are required for up to six weeks. Permanent macular damage and scotoma (inability to see in certain parts of the visual field) can occur. If the macular area is affected, complications can be more severe.

Early detection of complications is crucial for prompt treatment. Potential complications include:

• Macular hole: Tear in the macula
• Retinal hole: Tear in the retina
• Hyphema: Blood in the anterior chamber of the eye
• Lens subluxation: Displacement of the lens
• Orbital fracture: Fracture in the bones around the eyeball
• Glaucoma
• Cataracts

Prevention

Eye injuries that can lead to retinal commotion can be prevented through several measures:

• Use eye protection: Always wear eye protection during activities with high risks of exposure to dust, foreign objects, or flying objects. Supervise children if these activities are being performed nearby.
• Mowing the lawn: Wear eye protection and keep children away during lawn mowing.
• Secure sharp objects: Store sharp objects safely and out of children's reach.
• Avoid slippery objects: Prevent the use of slippery carpets. If living with elderly or children, ensure sharp furniture corners are covered to avoid injury from accidental impacts.
• Car safety: Use appropriate car seats with secure seat belts for children and avoid placing children under 12 years old in the front seat. Store loose items in the trunk.
• Toy safety: Avoid giving children toys that pose risks, such as shooting toys, toy guns, archery sets, and laser pointers which can damage the retina.
• Sports protection: Wear eye protection for sports involving balls, sticks, rackets, and other flying objects. Use eye protection approved by ASTM F803 standards. For professional athletes, polycarbonate lenses are recommended: 2 mm thick for low-impact sports and 3 mm for high-impact sports. Use face protection like helmets in sports like hockey, soccer, baseball, and lacrosse.
• Opening bottles: Be cautious when opening bottles to prevent caps from flying into your face.

When to See a Doctor?

Immediately consult an eye specialist if you experience a blow or injury to the eyeball, even if it seems minor. A thorough examination is crucial to detect any hidden damage within the eyeball. Delaying medical consultation can lead to severe damage and vision loss.

Before visiting the doctor:

• Avoid touching, rubbing, or pressing your eyes.
• Do not use any eye drops.
• Protect your eyes with a patch that does not adhere directly to the eyes until you reach a medical facility.
• Seek assistance from someone to transport you to a health facility.

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