METALLIC CHAIN REACTION- A TALE OF SEVERE OCULAR TRAUMA

Published 2025 - 29th ESCRS Winter Meeting

Reference: PO249 | Type: Presented Poster & Poster | DOI: 10.82333/c3xt-ff59

Authors: Angeliki Vassila* ¹ , Dimitra Mitsopoulou ¹ , Anastasios Sepetis ¹ , Francesco Stringa ¹

¹Ophthalmology Department,University Hospital Southampton NHS Foundation Trust,Southampton,United Kingdom

Purpose

To present the case of a 53-year-old male patient with severe bilateral blunt ocular trauma following assault.

Setting

University Hospital of Southampton NHS Foundation Trust.

Methods

A 53-year-old male, with no prior ophthalmic history, presented to the Emergency Department with facial blunt trauma following a metallic chain assault. Examination revealed scalp and forehead lacerations and bilateral periorbital ecchymosis. A retrobulbar hematoma was suspected in the left eye, necessitating an emergency canthotomy and cantholysis. Imaging showed no intracranial abnormalities or globe rupture. There was traumatic iritis, traumatic mydriasis, hyphaema, vitreous hemorrhage and hypotony in the right eye. Similar pathologies were identified in the left eye. However, the left eye developed crystalline lens dislocation and pupillary block, necessitating urgent lensectomy.

He underwent left eye 23-gauge Pars Plana Vitrectomy (PPV) with air tamponade, and lensectomy with insertion of 3-piece intraocular lens (IOL) with scleral fixation. The following day combined right phacoemulsification with IOL insertion and 23-gauge PPV was performed. Shallow nasal suprachoroidal haemorrhage and subretinal haemorrhages were present.

Results

Hypotony with macular folds persisted in the right eye. Ultrasound biomicroscopy showed extensive clefts and peripheral anterior synechiae. The recovery of the left eye was uneventful, and the visual acuity improved to 0.34 from hand movements at presentation. Oculoplastic reformation of the left lateral canthal angle was planned.

Conclusion

This case highlights the importance of a multidisciplinary approach in ocular trauma management, requiring daily input from multiple subspecialities. Although the left eye required emergency intervention, the complexity of treatment of the right eye was greater, with challenging management.