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Retinitis sclopeteria associated with airbag inflation
  1. R H Y ASARIA,
  2. A ZAMAN,
  3. P M SULLIVAN
  1. Moorfields Eye Hospital, City Road
  2. London EC1V 2PD
  1. Mr Asaria.

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Editor,—Chorioretinitis sclopeteria is a severe form of blunt trauma, caused by a high velocity object grazing the globe but not penetrating it. It is a concussion injury, which usually manifests as severe choroidal and retinal rupture associated with haemorrhage but an intact sclera.1 We report a case of chorioretinitis sclopeteria resulting from deployment of an airbag in a stationary motor vehicle.

CASE REPORT

A 32 year old pregnant woman was the driver in a car accident in which the airbag failed to deploy at the time of impact but inflated when she returned to sit in the driver’s seat approximately 5 minutes after the accident occurred. The patient was not wearing spectacles and there was no evidence of injury from other sources.

At presentation the visual acuity was hand movements in the left eye and 6/6 in the right eye. Examination revealed evidence of swollen eyelids and marked chemosis and subconjunctival haemorrhages on the left, with no bony injury and a full range of eye movements. Anterior segment examination revealed a clear left cornea and a quiet anterior chamber with a microhyphaema. The lens was clear and there was no evidence of subluxation. There was no angle recession and the intraocular pressure was recorded at less than 4 mm Hg. Fundal examination revealed evidence of a retinal tear although details were obscured by a diffuse vitreous haemorrhage. An ultrasound examination showed a vitreous haemorrhage and large retinal tear but no evidence of a scleral perforation.

An examination under anaesthesia performed the following day confirmed that there was no scleral rupture and indirect ophthalmoscopy confirmed the findings of diffuse vitreous haemorrhage and a retinal tear.

At the 2 week postoperative clinic visit, visual acuity had improved to 6/18. There was 2+ cells in the anterior chamber and the intraocular pressure was 24 mm Hg. Posterior segment findings were an intragel haemorrhage and retinitis sclopeteria with no evidence of retinal detachment.

Four months later, the best corrected visual acuity was 6/36. The anterior chamber activity had settled; the intraocular pressure was 10 mm Hg, and fundal examination was unchanged. In view of the persistent vitreous haemorrhage the patient was listed for routine pars plana vitrectomy in the postpartum period.

COMMENT

Airbags are designed to protect the driver from direct impact from the steering wheel, dashboard, and windscreen. They are designed to inflate in 10 ms in response to sudden deceleration and during deployment, the airbag is propelled out of its storage compartment at speeds of more than 100 mph.2 Following inflation the airbag deflates slowly within seconds.

Facial and ocular injuries associated with airbags have been reported in the literature. Skin abrasions, burns, and eyelid ecchymoses are the most common facial injuries. Reported ocular injuries include orbital fractures, keratitis, corneal abrasions, hyphaemas, angle recession, and lens subluxation. In the posterior segment, vitreous and retinal haemorrhages, commotio retinae, retinal tears and dialyses, and choroidal ruptures have been reported.3-8 To our knowledge, this is the first reported case of retinitis sclopeteria secondary to airbag inflation.

Although airbags have clearly been shown to reduce serious morbidity and mortality associated with road traffic accidents, they are associated with a number of injuries directly attributable to their inflation. Some of these are serious ocular injuries and it is important for ophthalmologists and others involved with trauma cases to be aware of these complications. A full ophthalmic assessment is mandatory in all cases and this should include indentation ophthalmoscopy. A variety of posterior segment injuries have been reported in the literature but this is the first report of retinitis sclopeteria resulting from airbag deployment.

References

Figure 1

Airbag injury with retinitis sclopeteria, an intragel haemorrhage, and attached retina.

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