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JAMA Ophthalmology Clinical Challenge
December 2018

An Unusual Complication of Ocular Trauma in a 10-Year-Old Girl

Author Affiliations
  • 1Division of Ophthalmology, Brown University Alpert Medical School, Providence, Rhode Island
JAMA Ophthalmol. 2018;136(12):1412-1413. doi:10.1001/jamaophthalmol.2018.2599

A healthy 10-year-old girl with a recent history of blunt trauma to the left eye presented to the emergency department with acute-onset blurry vision and pain. On her initial ophthalmic examination 3 weeks earlier, she was diagnosed with commotio retinae and traumatic iritis in the left eye after being struck with the brim of a hat. She was treated with a topical corticosteroid, with rapid resolution of iritis and commotio. However, she developed ipsilateral, asymptomatic grade 2 optic disc edema. Best-corrected visual acuity was 20/20 OU with a 2-diopter myopic shift in the left eye. There was no afferent pupillary defect, color vision was normal, and intraocular pressure (IOP) was 10 mm Hg OD and 8 mm Hg OS. Visual field testing revealed an enlarged blind spot in the left eye, and optical coherence tomography of the left eye revealed thickening of the retinal nerve fiber layer in all quadrants. The results of examination and testing of the right eye were unremarkable. The results of workup with a complete blood cell count, basic metabolic panel, angiotensin-converting enzyme measurement, Lyme disease testing, and antinuclear antibody measurement were unremarkable.

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