Indirect ocular trauma is damage or injury to the retina that is not direct. Possible causes of such trauma are fat embolism or facial skull fractures.
What is indirect ocular trauma?
In the case of visual disturbances, a detailed medical history should be taken first. In particular, recent accidents or injuries should be noted in the anamnesis. If indirect ocular trauma is suspected, fundus diagnostics are performed.
Indirect ocular trauma is damage to the retina. However, this damage was not due to direct trauma. There was no direct force on the eye socket before the symptoms appeared.
According to abbreviationfinder, indirect ocular trauma is usually caused by circulatory disorders that can be traced back to trauma in other parts of the body. Symptoms of the trauma can appear immediately or with a delay of several days. The therapy is mostly conservative. In the majority of cases, the damage caused recedes. However, this recovery process can take several weeks. Some patients have permanent visual disturbances or visual field defects.
Indirect ocular trauma is called indirect because it occurs without direct trauma to the eye socket (orbit). The trauma develops on the basis of a more distant act of violence. The cause is therefore injuries that may not even be close to the eye. These injuries affect and damage the retina in a number of ways.
The exact pathogenesis of indirect ocular trauma can be very different. When a long bone fractures, the fatty bone marrow can be damaged. Fat droplets can be released from the marrow and washed into the blood. This process is also known as fat embolism. The fat particles are transported further via the bloodstream and are deposited in the body. Most often, the fat particles get stuck in the lungs and cause a fat embolism there.
Depending on their size, however, they can pass through the pulmonary vessels and only get stuck in the smallest vessels of the retina. There they are deposited and cause an embolism. The small capillaries of the retina are closed. The blood can therefore no longer circulate and the tissue behind the occlusion is no longer supplied with oxygen and nutrients. As a result, it dies.
Another cause of indirect ocular trauma is a chest (thoracic) injury. An embolism causes an increase in pressure in the chest. This increase in pressure also affects the vessels. The pressure is transmitted in a wave through all the vessels in the body. If it reaches the small vessels of the eye, it can rupture or spasm.
The result is an acute undersupply of the retina. This undersupply due to insufficient blood flow is referred to as ischemia. Car accidents can also result in indirect ocular trauma. Compression of the chest by the seat belt in particular can cause damage to the eye.
A special form of indirect ocular trauma is altitude retinopathy. In the event of severe fluid loss or at very high altitudes, the hematocrit and hemoglobin concentrations in the blood are increased. The increase in these two blood components increases blood viscosity, which can cause small vessels, such as those in the retina, to become clogged.
Symptoms, Ailments & Signs
Indirect ocular trauma can cause a wide range of symptoms and conditions. The first signs of trauma usually only appear a few days after the triggering event. Typically, after three to five days, mild to moderate visual disturbances set in, which become worse over the following days. Those affected often suffer a loss of vision.
This is a disorder that results in rigid visual acuity. As a result, the eye can no longer adjust to different visual situations, which leads to considerable limitations in everyday life. If indirect ocular trauma is treated early, vision loss can often be averted. However, other symptoms usually occur in the eyes, such as pain or discomfort.
In extreme cases, it can lead to complete blindness. The visual disturbances are irreversible and often precede psychological problems. As a result of indirect ocular trauma, young people often suffer from psychological upsets, which can develop into pronounced depression over the course of the disease. Externally, the trauma can be recognized by visible injuries, bruising or skin changes, among other things, depending on the cause and severity of the indirect ocular trauma.
Diagnosis & course of disease
In the case of visual disturbances, a detailed medical history should be taken first. In particular, recent accidents or injuries should be noted in the anamnesis. If indirect ocular trauma is suspected, fundus diagnostics are performed. The back of the eye is examined with an ophthalmoscope.
With the help of a magnifying glass, the attending physician looks through the pupil into the inside of the eye. The eye is simultaneously illuminated with a light source. Bleeding within the retina can be seen on ophthalmoscopy.
A typical examination finding is a so-called cotton-wool herd. These are cotton ball-like shadows in the area of the retina. These are white or yellowish in color. These cotton-wool spots are caused by swelling of the nerve fibers in the fibrous layer of the retina (stratum neurofibrarum). They arise because the neuroaxonal transport is also impaired by the ischemia.
This trauma can lead to various discomforts or complications. These usually depend on the cause of the trauma, so that a clear course of the disease cannot be predicted. Most of the time, however, this causes problems in the eyes. Patients usually suffer from visual disturbances or pain in the eye.
In the worst case, those affected suffer complete blindness, which can no longer be treated and is therefore irreversible. In many cases, the patient is no longer able to see clearly. It also comes to a veiled vision or so-called double vision. The quality of life of those affected is significantly reduced by this trauma. Young people in particular suffer from depression or other mental disorders due to visual problems.
However, life expectancy is usually not reduced by this trauma. It is not uncommon for the trauma to lead to further facial defects, which can make everyday life more difficult for the person affected. The treatment itself does not lead to further complications. However, most of the damage cannot be repaired, so the patient may need visual aids.
When should you go to the doctor?
If there are indications of a circulatory disorder, a doctor should be consulted. When there is dysfunction in the head area, there is cause for concern. A doctor should be consulted as soon as vision problems, headaches or a feeling of pressure in the eyes occur. Changes in vision, flickering in front of the eye, problems with sharp vision or signs of eye fatigue must be examined and treated. If the changes appear immediately after a violent impact on the eye, a check-up is recommended as soon as possible. After an accident or act of violence, a doctor is needed as soon as there has been a forceful impact on the eye or face area. Discolouration in the eye, bleeding in the eye or deformation of the eye socket must be examined by a specialist.
If there are failures of the facial muscles or nerves, a doctor should be consulted. To minimize permanent damage to vision or blood vessels, it is advisable to consult a doctor or go to a hospital immediately after the damage. If there is an unusual discharge of secretions from the eye, this is a warning from the organism that injuries and damage are present. A doctor is also needed if you feel pressure in your chest, have problems breathing or if you feel generally unwell. In case of anxiety, pain or lung problems, a doctor should be consulted.
Treatment & Therapy
Usually, the findings in the fundus area resolve on their own within four to six weeks. In some cases, visual impairments or visual field defects remain. If vision problems persist, high-dose steroids or prostaglandin inhibitors can be tried.
In the case of high-altitude retinopathy, the focus is on normalizing the hemoglobin and hematocrit values. For this, the patients are administered isovolemic hemodilutions. The drugs pentoxifylline and aspion are also used.
Outlook & Forecast
The prospect of suffering indirect ocular trauma increases in the event of an accident involving a thoracic injury, a fracture of a long bone, or a fat embolism caused by such incidents. In these cases, indirect trauma to the retina must be considered in subsequent visual disturbances. The treatment must aim to ensure that no consequential damage remains in the eye. The chances of that happening are pretty good.
Since an indirect ocular trauma cannot be traced back to a direct effect on the area surrounding the eye, the associated damage to the retina often occurs with a delay due to a cause that was actually effective elsewhere. The triggering causes of this occurrence need to be treated first. However, the prognosis for indirect ocular trauma is quite good because the resulting side effects can be easily treated with conservative therapy.
The indirect traumatization of the eye can sometimes be triggered by causes that are so far away from the eye that a connection must first be established. In most cases, the consequences of indirect ocular trauma can resolve within several weeks. Permanent damage to the eye remains in only a proportion of those affected. These can persist, for example, as visual field defects or visual disturbances. It must be decided on a case-by-case basis whether these can still be improved with medication or at least the effects can be mitigated.
High altitude retinopathy can be prevented by preparing well for a stay at high altitude. Appropriate ascent and descent stages should be observed. This ensures that the body can get used to the different air conditions.
The normal form of indirect ocular trauma is difficult to prevent. However, if visual disturbances occur after an accident, an ophthalmologist should be consulted as soon as possible.
Indirect ocular trauma requires timely treatment and targeted aftercare. This includes, among other things, prevention. Depending on the situation, those affected can adjust to higher altitudes, for example, by preparing properly. This reduces the risk of altitude retinopathy.
Reducing the speed when going up and down is also helpful for getting used to the body. In the classic form of the disease, however, there are only a few options for prophylaxis. In connection with an accident, those affected should consult an ophthalmologist immediately if they have visual disturbances. The disruption of normal visual function has an extremely distressing effect on patients.
They should remain as calm as possible and not panic. Stress could have negative consequences on the condition and reduce the chances of recovery. It is therefore important that those affected take the necessary rest. At home or in a familiar environment, they can avoid major difficulties.
This also means increased protection of the eyes from external influences. Direct sunlight, strong winds and large temperature fluctuations are to be avoided, as is staring at a screen for a long time. Those affected should also avoid contact with cosmetics and even water to avoid irritation.
You can do that yourself
Indirect ocular trauma is usually associated with impairments of the usual visual function and is therefore very distressing for those affected. Nevertheless, it is important to remain calm and to avoid stress if possible, as this can have a negative effect on the state of health and the chances of recovery. At best, patients allow themselves sufficient rest and spend a lot of time at home or in familiar surroundings to avoid difficulties.
It is particularly important to protect the eyes from strong external influences, such as wind, sunlight, cold and heat. In addition, it is not advisable to spend hours every day in front of various screens, as this takes a lot of strain on the eyes. Contact with water and cosmetics should also be avoided to prevent eye irritation and the disease regressing. In this context, meticulous hygiene in the area of the diseased eye must also be observed, because contamination sometimes has serious consequences for the further course of the disease.
In the case of an indirect ocular trauma, patience is required from the patient. In certain situations it is advisable to get help from other people in order to avoid mistakes or accidents caused by impaired vision.