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Tears of the retinal pigment epithelium (RPE) were first described in 1981 by Hoskin et al1 as a complication of detached pigment epithelium in patients with age-related macular degeneration. Since then, RPE tears have also been described in patients with chorioretinal scarring in retinal detachments, with subretinal neovascular membranes, following glaucoma surgery, and after laser photocoagulation of pigment epithelium detachments.2-4 We describe a patient who developed an RPE tear following blunt trauma to the eye. Ultra-high resolution optical coherence tomography was performed, and it provided unprecedented visualization.
A 43-year-old woman reported falling and hitting her head and left eye on a wooden rail 1 week prior to her initial visit. After the swelling in her left eye subsided, she noticed decreased vision in that eye. At the time, the best-corrected visual acuities were 20/100 OD and 20/70 OS. Ocular history was significant for amblyopia in the right eye. Amsler grid testing of the left eye revealed areas of waviness and a scotoma in the center of the grid. Intraocular pressures were 15 mm Hg OU. Dilated fundus examination results of the right eye were normal whereas the left eye showed a well-demarcated area of RPE loss in the macula that was elevated with fluid. A scroll of pigmented RPE was noted infranasally (Figure 1A), and a horseshoe tear with surrounding subretinal fluid was noted superotemporally (located outside of the photographic field). Fluorescein angiography showed an early window defect from the lost RPE measuring several disc areas in size and involving the entire temporal and superior macula. A band of blocked fluorescence on the nasal margin was consistent with the scroll of RPE (arrow in Figure 1B). Ultra-high resolution optical coherence tomography was performed using a standard protocol. The horizontal temporonasal scan revealed a large area of subretinal fluid in the fovea. The area of RPE distortion in the nasal region (arrow in Figure 2) corresponds to the clinical finding of scrolled RPE as a result of retraction and folding of the RPE following the tear.
Chan A, Duker JS, Ko TH, Schuman JS, Fujimoto JG. Ultra-High Resolution Optical Coherence Tomography of Retinal Pigment Epithelial Tear Following Blunt Trauma. Arch Ophthalmol. 2006;124(2):281–283. doi:10.1001/archopht.124.2.281
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