Traumatic Macular Hole

This 21 year old man was assaulted and struck in the right eye with a fist. Resolving periorbital bruising can be seen in panel A at the yellow arrow. He complained of blurred central vision of the right eye. Visual acuity of this eye was 20/80. Panel B shows that he had a macular hole with typical white dots in the base (blue arrow). The spectral domain OCT image (panel C) shows that the edges of the hole, even if flattened, would not appose (orange arrow), a sign implying a guarded prognosis if repair were attempted. In such cases it may be possible to flatten the hole, but a continuous sheet of neurotetina across the fovea may not be attained. In some cases a glial plug of scarring may bridge the gap. In panel D the normal OCT of the fellow eye is shown for comparison. Note the normal contour of the foveal depression (red arrow). The patient had not decided whether he wished to attempt surgical repair at the time of this posting.