
==== Front
J Curr Ophthalmol
J Curr Ophthalmol
JCO
J Curr Ophthalmol
Journal of Current Ophthalmology
2452-2325
Wolters Kluwer - Medknow India

JCO-35-408
10.4103/joco.joco_77_23
Case Report
Spontaneous Resolution of Posttraumatic Retinal Pigment Epithelium Tear and Associated Exudative Retinal Detachment
Panigrahi Pradeep Kumar 1
Minj Anita 1
Thareja Japesh 1
Navyasree Chinthala 1
Veerla Laukya Jyothsna Devi 1
1 Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
Address for correspondence: Pradeep Kumar Panigrahi, Department of Ophthalmology, Institute of Medical Sciences and Sum Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), 8-Kalinga Nagar, Bhubaneswar - 751 003, Odisha, India. E-mail: doc.pkp25@gmail.com
Oct-Dec 2023
10 8 2024
35 4 408410
05 4 2023
09 7 2023
09 7 2023
Copyright: © 2024 Journal of Current Ophthalmology
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Purpose:

To report a case of posttraumatic retinal pigment epithelium (RPE) tear complicated with exudative retinal detachment that underwent spontaneous resolution.

Methods:

Case report.

Results:

A 61-year-old healthy female presented with sudden-onset loss of vision in the left eye for 5 days following blunt trauma. She had undergone left upper eyelid and eyebrow laceration repair elsewhere. A comprehensive ophthalmic examination revealed a subfoveal RPE tear with exudative retinal detachment in the left eye. There was spontaneous healing of RPE tear and complete resolution of exudative retinal detachment 2 weeks following the initial presentation.

Conclusions:

RPE tear is an extremely rare complication following blunt trauma. The size of the RPE tear can play an important role in determining the final visual prognosis in such cases.

Exudative retinal detachment
Retinal pigment epithelium tear
Trauma
==== Body
pmcINTRODUCTION

Retinal pigment epithelium (RPE) tears and rips are commonly seen in patients with age-related macular degeneration and following intravitreal injections.12 Blunt trauma can lead to a variety of posterior segment complications such as commotio retinae, macular hole, choroidal rupture, retinal dialysis, retinal detachment, and optic nerve damage.3 RPE tear is a very rare complication following blunt trauma. The purpose of this case is to report a very interesting finding of posttraumatic RPE tear complicated with an exudative retinal detachment that underwent spontaneous resolution.

CASE REPORT

A 61-year-old healthy female presented with sudden-onset loss of vision in her left eye of 5-day duration. There was a positive history of accidental fall of a ceiling fan on the patient’s face 5 days back. The patient was diagnosed with full-thickness lacerated injury involving her left upper eyebrow and eyelid. The lacerated wound had been repaired elsewhere. At the time of presentation, the patient was on oral ciprofloxacin (500 mg), paracetamol (650 mg), topical moxifloxacin (0.5%), and artificial tears. She never had any other ocular issues in the past.

On examination, the visual acuity was 20/30 and 20/240 in the right and left eye, respectively. Examination revealed a repaired lacerated wound involving the left upper eyelid and eyebrow. Ocular movements were full in both eyes. A slit-lamp examination of the right eye showed nuclear sclerosis Grade I. A slit-lamp examination of the left eye revealed mild corneal haze, small iridodialysis between 1 and 2 ‘o’clock hours, cells 1+, and nuclear sclerosis Grade II. The pupillary reaction was normal in both eyes. Intraocular pressure measured using a noncontact tonometer was 15 and 19 mmHg in the right and left eyes, respectively. Dilated fundus examination of the right eye was unremarkable. Funduscopy of the left eye revealed the presence of subretinal fluid involving the macular area [Figure 1a]. Optical coherence tomography of the left eye showed neurosensory detachment with a small area of RPE tear subfoveally [Figure 1b]. The patient was advised to undergo fundus fluorescein angiography which was denied by the patient.

Figure 1 (a) Color fundus photograph of the left eye at presentation showing subretinal fluid in the macula (white arrow). (b) Optical coherence tomography of the left eye at presentation showing subfoveal retinal pigment epithelium tear (white arrow) with neurosensory retinal detachment (exudative)

The left eye was diagnosed with posttraumatic uveitis with RPE tear and exudative retinal detachment. Systemic investigations including complete blood count, blood pressure, blood sugar, lipid profile, serum urea, and creatinine were within normal limits. Guarded visual prognosis was explained to the patient. The patient was started on topical prednisolone (1%) eye drop to treat the uveitis component. Two weeks following the initial presentation, the visual acuity in the left eye had improved to 20/30. Fundus examination revealed RPE alterations in the macula with complete resolution of subretinal fluid [Figure 2a]. Optical coherence tomography of the left eye showed complete resolution of exudative retinal detachment with healing of the RPE tear [Figure 2b]. The patient was advised to undergo regular ophthalmic checkups. All patient-related consents have been obtained.

Figure 2 (a) Color fundus photograph of the left eye 2 weeks following presentation showing resolution of subretinal fluid with retinal pigment epithelial alterations (white arrow). (b) Optical coherence tomography image of the left eye 2 weeks following presentation showing complete resolution of neurosensory retinal detachment with healing of retinal pigment epithelium tear (white arrow)

DISCUSSION

RPE tear is a well-known complication of pigment epithelial detachment and can lead to significant visual impairment. The most common cause of RPE tear is a vascularized pigment epithelium detachment in association with the wet type of age-related macular degeneration.1 The advent of intravitreal anti-vascular endothelial growth factor therapy has increased the risk of such type of complications which can compromise the final visual acuity gained. RPE tears are extremely uncommon following blunt trauma. RPE tear consists of disruption of the RPE monolayer by underlying tangential forces. It is postulated that the force following blunt trauma should be extremely localized to a narrow window to produce exclusively RPE tear.4 If the force is too high, it will lead to a choroidal rupture and if it is too less, it will not lead to a tear.

RPE tears following blunt trauma have been rarely reported in the literature.456 Chan et al. reported a case of RPE tear with exudative retinal detachment in a 43-year-old woman.4 The patient was treated with laser photocoagulation. Although there was complete resolution of exudative detachment, there was progressive deterioration of vision in the affected eye. Doi et al. reported a case of peripheral RPE tear with extensive exudative detachment.5 The eye was initially treated with cryotherapy, followed by sclerectomy and sclerotomy.

Experimental studies have shown that 1 week after RPE tear, a layer of flattened, depigmented cells replace the area of stripped RPE.7 Our case varies from the above-reported cases as there was a spontaneous resolution of exudative detachment and healing of RPE tear without any active intervention. The relatively small size of the RPE tear and its rapid healing might have possibly led to a better visual prognosis in our case. This case is similar to the case of a spontaneous resolution reported by Fok et al.6

To conclude, RPE tear is an extremely uncommon complication following blunt trauma. Visual prognosis is usually poor in such cases. The size of the RPE tear can play an important role in determining the final visual prognosis in such cases.

Declaration and patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
==== Refs
REFERENCES

1 Sastre-Ibáñez M Martínez-Rubio C Molina-Pallete R Martínez-López-Corell P Wu L Arévalo JF Retinal pigment epithelial tears J Fr Ophtalmol 2019 42 63 72 30594420
2 Cho HJ Kim HS Yoo SG Han JI Lew YJ Cho SW Retinal pigment epithelial tear after intravitreal ranibizumab treatment for neovascular age-related macular degeneration Retina 2016 36 1851 9 27074658
3 Williams DF Mieler WF Williams GA Posterior segment manifestations of ocular trauma Retina 1990 10 Suppl 1 S35 44 2191381
4 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 124 281 3 16476903
5 Doi M Osawa S Sasoh M Uji Y Retinal pigment epithelial tear and extensive exudative retinal detachment following blunt trauma Graefes Arch Clin Exp Ophthalmol 2000 238 621 4 10955665
6 Fok AC Lai TY Wong VW Wong AL Lam DS Spontaneous resolution of retinal pigment epithelial tears and pigment epithelial detachment following blunt trauma Eye (Lond) 2007 21 891 3
7 Korte GE Reppucci V Henkind P RPE destruction causes choriocapillary atrophy Invest Ophthalmol Vis Sci 1984 25 1135 45 6480292
