A 22-year-old man is struck by a tennis ball on the right eye. Fundoscopy shows grey-white opacification of the outer retina at the posterior pole with the choroidal vasculature still visible beneath it. Visual acuity is reduced. The appropriate management is:

• A Urgent intravitreal anti-VEGF injection
• B Observation with serial fundoscopy watching for macular hole formation ✓
• C High-dose systemic corticosteroids
• D Early pars plana vitrectomy

Explanation

These are the findings of commotio retinae, or Berlin oedema, caused by disruption of photoreceptor outer segments and retinal pigment epithelium after shock wave transmission from blunt trauma. There is no true intraretinal fluid, and the opacification usually clears completely within weeks without treatment. When the fovea is involved, the specific danger to monitor is secondary full thickness macular hole, which needs vitrectomy if it develops.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.