Trauma and chorioretinal shockwave injury from intra-orbital foreign body.

High-velocity projectile trauma could lead to intra-orbital foreign body and concomitant chorioretinal shockwave injury in the absence of open-globe injury. Management depends on the types, size, and location of foreign bodies.

Traumatic chorioretinitis sclopetaria: Risk factors, management, and prognosis.

PURPOSE: To describe new cases of sclopetaria and evaluate the risk factors, management, and visual prognosis of all reported cases in the literature. OBSERVATIONS: We performed a retrospective, observational case series. This study included six cases (median age 23, interquartile range 33) of sclopetaria. Additionally, literature searches were conducted in the PubMed and Cochrane Library databases to uncover risk factors associated with all published cases of sclopetaria. Main outcome measure was best corrected visual acuity (BCVA) worse than 20/20. Sixty-seven cases (71 eyes) of sclopetaria have been reported, of which 59 cases (61 eyes) met inclusion criteria in this study. Most were young (median age 19.5 years) men (51/59, 88.1%). Thirty-seven eyes were observed while 24 underwent immediate surgery including six pars plana vitrectomies and three scleral buckles. Compared to initial presentation, BCVA improved in 31/48 (64.6%) eyes, remained stable in 12/48 eyes (25.0%), and worsened in 5/48 eyes (10.4%). Ten patients (16.4%) achieved a final BCVA of 20/20 with median follow up time of seven months. In a multivariate model, location of sclopetaria in the macula, temporal retina, or immediate orbital foreign body removal predicted poor final BCVA with an area under receiver operating characteristic curve of 0.767. CONCLUSIONS AND IMPORTANCE: Traumatic chorioretinitis sclopetaria is rare, but reports have increased dramatically over the past two decades. While pars plana vitrectomy may be required for the management of retinal detachments and non-clearing vitreous hemorrhage, close observation is appropriate in most cases. Visual prognosis is poor with most patients attaining 20/200 vision or worse.

Coriorretinopatía esclopetaria manejada con vitrectomía pars plana temprana. Reporte de un caso / Chorioretinitis sclopetaria managed with early pars plana vitrectomy. Case report

Resumen Introducción La coriorretinopatía esclopetaria es una rara entidad resultante de un trauma por proyectil de alta velocidad que haya pasado adyacente o a través de la órbita, sin penetrar el globo ocular. Provoca daño coriorretiniano de espesor completo y pérdida visual. Objetivo Presentar un caso clínico de esta rara entidad, tratada de manera poco habitual, dados los hallazgos clínicos iniciales y con buen resultado final. Reporte de un caso Masculino de 42 años de edad, que refirió una fuerte detonación de arma de fuego cerca del globo ocular. Presentó baja visual los días posteriores y se diagnosticó hemovítreo; se realizó un ultrasonido ocular, el cual reportó desgarro retiniano, por lo que se realizó vitrectomía pars plana. Al final del seguimiento, se encontró con capacidad visual de cuenta dedos a 30 cm. Se realizaron estudios complementarios para documentar los hallazgos clínicos, presentando fractura coroidea con involucro macular. Se describe su seguimiento por cuatro semanas; se mantiene con estabilidad visual, sin complicaciones posteriores. Conclusiones Presentamos el caso de una coriorretinopatía esclopetaria, la cual está escasamente reportada. Hasta el momento, es el primer caso tratado con vitrectomía temprana sin complicaciones posteriores y estabilidad visual posterior.

Abstract Introduction Chorioretinitis sclopetaria is a rare entity resulting from trauma by a high-velocity projectile that passed adjacent or through the orbit without penetrating the eyeball. It causes full-thickness chorioretinal damage and visual loss. Objective To present a clinical case of the entity treated in an unusual way, with a good result. Case report 42 year-old male who mentioned a strong firearm detonation near the eyeball. Days later, he presented with visual loss, and hemovitreous was diagnosed. An ocular ultrasound was done, which reported retinal tear, so a pars plana vitrectomy was performed. At the end of the follow up, there was a visual ability to count fingers at 30 cm. Complementary studies were carried out to document the clinical findings, showing a choroidal fracture with macular involvement. Follow-up was carried up to four weeks after the intervention, without complications and with visual stability. Conclusions We present a case of chorioretinitis sclopetaria, which is scarcely reported; so far, this is the first case treated with early vitrectomy without later complications.

Chorioretinitis sclopetaria caused by an intraorbital metallic foreign body / Coriorretinite esclopetária causada por um corpo estranho metálico intraorbitário

ABSTRACT A 44-year-old man was referred for evaluation of pain and temporal floaters after receiving a rebounded bullet impact to his right eye. Typical funduscopic findings, together with the confirmed presence of an intraorbital metallic foreign body, led to the diagnosis of chorioretinitis sclopetaria. Conservative management was performed as no severe symptoms were observed. The favorable clinical outcome was confirmed in subsequent reviews. Chorioretinitis sclopetaria is characterized by a proliferative chorioretinal inflammation as a consequence of the expansive wave caused by the entrance of a bullet between the eyeball and the orbit.

RESUMO Um homem de 44 anos foi encaminhado para avaliação de dor e flutuadores temporais após receber um impacto de bala ressaltado em seu olho direito. Achados fundoscópicos típicos, juntamente com a presença confirmada de um corpo estranho metálico intraorbitário, levaram ao diagnóstico de coriorretinite esclopetária. O manejo conservador foi realizado, pois não foram observados sintomas graves. O desfecho clínico favorável foi confirmado em revisões subsequentes. A coriorretinite esclopetária é caracterizada por uma inflamação coriorretiniana proliferativa como consequência da onda expansiva causada pela entrada de uma bala entre o globo ocular e a órbita.

Intraorbital foreign body: A rifle bullet removed 20 years after the accident.

INTRODUCTION: Trauma of the orbit and eyeball is common, but intraorbital bullet is a relatively rare event. CLINICAL CASES: The authors report the management of a patient with chorioretinitis sclopetaria secondary to a gunshot wound twenty years previously. DISCUSSION: The clinical, diagnostic and therapeutic aspects of this unusual case of intraorbital foreign body are discussed.