https://doi.org/10.

1007/s00417-010-1414-x
Blunt trauma results in anterior
and posterior segment injuries
Low Kah Ling1,2, Amelia Lim1, Nor Azita1, Hamisah Ishak1, Jemaima Che Hamzah2
1
Department of Ophthalmology, Hospital Kuala Lumpur
2
Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre

Introduction:
Ocular blunt trauma is an ophthalmic
emergency and may cause various intraocular
injuries involving the anterior and posterior
segment.
 
Case report: Diagram 1: Anterior segment Diagram 2: Anterior segment
A 46-year-old male prisoner allegedly photo preoperatively photo postoperatively
Discussion:
kicked into the right eye by a fellow inmate.
Ocular blunt trauma encompasses a wide
Post trauma, he developed pain in the right eye
spectrum of presentation. A concurrent
with visual loss.
damage to both the anterior and the posterior
On examination, left eye was normal and
segment is a complex ophthalmic trauma.
the right eye had hand motion (HM) vision.
Evaluation includes a proper history, visual
Right eye intraocular pressure (IOP) was
acuity, adequate examination to rule out open
36mmHg with cornea oedema. The anterior
globe injury and ascertain risk of
chamber (AC) was shallow with presence of
endophthalmitis.1 Management strategy is
subluxated lens temporally. There was
constructed accordingly. Operation can be
hyphaema and vitreous prolapse in AC
carried out in a staged approach or primary
associated with iridodialysis from 2 to 8 o’clock
comprehensive reconstruction2 as in our case.
position (Diagram 1). Fundus view was poor
Complex ophthalmic trauma is associated
due to vitreous hemorrhage, however B-scan
with greater risk of complications, namely
showed flat retina.
secondary glaucoma, sympathetic ophthalmia
A combined pars plana lensectomy,
and phthisical bulbi.1 Timely management can
iridoplasty, scleral fixation of intraocular lens,
reduce the risk of complications, however the
vitreous clearance was performed.
prognosis of complex ophthalmic trauma is
Intraoperatively, there was a retinal dialysis at
poor and largely depends on the original
1-3 clock hour with shallow retina detachment
injury.2
seen superiorly. Cryoretinopexy was performed Conclusion:
and retina was tamponade with A direct blow to the globe can cause devastating
perfluoropropane (C3F8) 12% gas (Diagram 2). damage to various vital intraocular structures.
One month postoperatively, his IOP Vision restoration is sometimes unattainable
became persistently high despite anti- despite extensive surgical intervention.2
inflammatory and maximum antiglaucoma References:
medications. Gonioscopy revealed angle 1. Witherspoon CD, Kunh F, Morris R, et al. (1995). Anterior and
posterior segment trauma. In: Master Techniques in Ophthalmic
recession. Subsequently, he underwent Surgery. p. 538–47.
glaucoma drainage device implantation. At final 2. Irawati, Y, Soedarman, S, Arianti, A, et al. (2021). Multiple
follow-up, his visual acuity was 6/18 with IOP Approaches for Managing Complex Ophthalmic Blunt Trauma: A
Case Report. International medical case reports journal, 14, 205–
of 12mmHg. 210.