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Trauma to the Eye



Figure 1. Macroscopic picture: Mild hyperemia of bulbar conjunctiva with anterior chamber totally filled by bright red, blood. Figure 2. Biomicroscopic picture: Mild bulbar conjunctival hyperemia, clear cornea, clear anterior chamber, pupil in medium mydriasis and clear lens.

Patrícia Sofia Pereira Maio1, Gabriela Nunes Botelho1, Tiago Maria Tavares Morais Sarmento2, Susana Maria Grilo Gomes Godinho1

Keywords : blood in anterior chamber, ocular trauma

Question:
A 16-year-old caucasian male with unremarkable family history and a personal history of left sided nephrectomy done at 8 years of age for a non-functional left kidney was hospitalized with intense ocular pain and sudden decrease in visual acuity of the left eye after an injury caused by a ball strike during a football match. On physical examination, he was conscious with Glasgow Coma Scale (GCS) of 15/15, had a mild hyperemia of bulbar conjunctiva of the left eye with anterior chamber totally filled by bright, red blood (Figure 1). Ocular movements were preserved. There were no other signs of trauma elsewhere in the body. Systemic examination was normal. Slit-lamp examination revealed left eye anterior chamber totally filled with blood, thus iris, lens or fundus could not be visualized. Intraocular pressure (IOP) was 44 mmHg in the left eye. Blood tests revealed a normal hemogram without coagulation disorders. Cranium and orbital computed tomography did not show signs of other hemorrhages or fractures. He was given bed rest and head elevation and started on hypotensive topical drugs (dorzolamide 2% bid, brimonidine 0.2% bid, cyclopentolate 1% tid, fluormetholone 0.1% tid) for seven days. There was a progressive decrease of the blood level in the anterior chamber and IOP (21 mmHg at second day after injury) and, therefore, was discharged home. Five days after the injury, during the biomicroscopic examination, there was a clear cornea, clear anterior chamber and clear lens (figure 2). The retinal reflex was normal. The patient did not suffer any rebleeding episode. Surgical intervention was not necessary. At the end of one-month, visual acuity was 10/10 and there was normalization of intraocular pressure.
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