Kerala Journal of Ophthalmology

: 2021  |  Volume : 33  |  Issue : 2  |  Page : 123--125

Acute traumatic maculopathy

Shruthy Vaishali Ramesh1, Prasanna Venkatesh Ramesh2, Meena Kumari Ramesh1, Ramesh Rajasekaran3,  
1 Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India
2 Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India
3 Department of Paediatric Ophthalmology and Strabismus, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India

Correspondence Address:
Dr. Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Private Limited, No. 6, Tennur, Seshapuram, Trichy - 620 017,Tamil Nadu


Traumatic retinopathy may occur secondary to direct or indirect trauma to the globe. Presentation of retinopathy may either be a coup (direct site of injury) and or contre-coup (distant sites including the macula). Commotio retinae in the posterior pole is referred to as Berlin's edema. The fovea is extremely thin, and blunt trauma may cause a full-thickness macular hole by either one or a combination of mechanisms, including contusion necrosis and vitreous traction. Holes may be noted immediately or soon after blunt trauma due to severe Berlin's edema, or after a subretinal hemorrhage caused by a choroidal rupture, or following severe cystoid macular edema, or after a whiplash separation of the vitreous from the retina. Post-traumatic macular holes (TMHs) may be successfully closed with vitrectomy and gas injection. We report a case of blunt trauma leading to Berlin's edema and TMH.

How to cite this article:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Acute traumatic maculopathy.Kerala J Ophthalmol 2021;33:123-125

How to cite this URL:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Acute traumatic maculopathy. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Dec 5 ];33:123-125
Available from:

Full Text

A 20-year-old male patient presented with an injury to the left eye with a cricket ball following which he experienced a sudden loss of vision. He had a visual acuity of 20/400 in the left eye. On evaluation, anterior segment was normal. Fundus evaluation revealed Berlin's edema with traumatic macular hole (TMH) [Figure 1]a. Optical coherence tomography (OCT) macula revealed full-thickness macular hole with retinal thickening and para-foveal disruption of the outer segment [Figure 1]b.{Figure 1}

Blunt trauma causes expansion of the globe in the equatorial region, which leads to a combination of anteroposterior vitreoretinal and tangential retinal traction, leading to a central defect in the fovea.[1],[2]

 Clinical Finding

This acute traumatic maculopathy presented with TMH with Berlin's edema.


Fundus examination reveals glistening gray-white opacification of the neurosensory retina in the macula region, mimicking a pseudo cherry-red spot with a round or ellipsoid full-thickness defect of the neurosensory retina [Figure 1]a.[3]

Optical coherence tomography

Optical coherence tomography (OCT) macula revealed full-thickness macular hole with retinal thickening and parafoveal disruption of the outer segment [Figure 1]b.


At 3 months follow up, patient presented with a fundus photograph [Figure 2]a revealing macular scarring with reduction of glistening cherry red spot and resolved disc haemorrhages. The OCT macula [Figure 2]b revealed macular scarring with complete disruption of the outer segment and inner segment /outer segment junction.{Figure 2}

Seen in

This condition is seen in activities associated with blunt trauma to the face and orbits, especially high-impact sports activities (commonly ball sports), violence, and motor vehicle accident.

Who described it?

Berlin's edema - First described by Berlin in 1873Macular hole - First described by Knaap in the late 1869 and later described by Noyes in 1875.

Cardinal diagnostic features?

Diagnosis is clinical and is made based on the characteristic appearance. However, OCT is imperative in diagnosing and managing this disorder. It provides a high-resolution image for the evaluation of macula in cross-section and three-dimensional view. OCT can help detect subtle TMHs as well as stage obvious ones.

Why it occurs?

Blunt trauma causes displacement of the lens-iris diaphragm with the expansion of peripheral structures outward. This causes stretching and tearing of ocular tissues, secondary to vitreoretinal deformation caused by the transmission of hydraulic forces. The retina is inelastic and absorbs the full effect of shock waves, resulting in injury to various layers mainly the outer segment of photoreceptor and retinal pigment epithelium (RPE) junction causing Berlin's edema.

The hypotheses behind the development of TMHs are the tangential and anteroposterior vitreoretinal traction.

What else to examine?

Rule out the seven rings of trauma:

Sphincter pupillae tearThe iris base for iridodialysisAnterior ciliary body traumaSeparation of ciliary body from scleral spurTrabecular meshwork tear/flapZonular dialysisRetinal attachment at ora serrata.

Declaration of patient consent

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

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Budoff G, Bhagat N, Zarbin MA. Traumatic macular hole: Diagnosis, natural history, and management. J Ophthalmol 2019;2019:5837832.
2Johnson RN, McDonald HR, Lewis H, Grand MG, Murray TG, Mieler WF, et al. Traumatic macular hole: Observations, pathogenesis, and results of vitrectomy surgery. Ophthalmology 2001;108:853-7.
3Blanch RJ. Understanding and preventing visual loss in commotio retinae, in College of Medical and Dental Sciences. University of Birmingham: Birmingham, UK: University of Birmingham; 2014. p. 581.