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Choroidal ischaemic infarction following ocular contusion with small framed spectacles: Hutchinson-Siegrist-Neubauer- syndrome
  1. A Viestenz,
  2. M Küchle
  1. Department of Ophthalmology, University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany
  1. Correspondence to: Arne Viestenz, MD, Department of Ophthalmology, University Erlangen-Nuernberg, Schwabachanlage 6, D-91054 Erlangen, Germany; Arne.Viestenz{at}t-online.de

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We read with interest the article by Clarke et al.1 The authors describe their findings in a 79 year old aphakic woman with a so called non-penetrating injury caused by compression with small framed spectacles. This type of injury is defined to be a contusion/closed globe injury.2

The authors presented a fundus photograph that they interpreted as a “choroidal rupture following blunt injury to the globe.” In the superior hemisphere, there was a large temporally localised area with hypopigmentation and malperfusion of the choroid, corresponding to the segmental structure of the choroidal vasculature.3 However, the findings shown by the authors are more indicative of a segmental choroidal infarction (Hutchinson-Siegrist-Neubauer-syndrome).4 A choroidal rupture typically presents as an arched choroidal defect at the posterior pole following indirect trauma or with other well defined defects in case of direct trauma. We found in all of our patients (7% of all severe contusions) with choroidal rupture a circumscribed and/or sickle shaped configuration.5

By contrast, this clinical picture of a segmental traumatic choroidal infarction was first described by Hutchinson in 1889.6 Siegrist confirmed this new disease in 1895.7 Neubauer observed in three patients the typical segmental choroidal atrophy with corresponding visual field defects.8 Lang and associates explained this severe complication following ocular contusion as follows: as a result of Bell’s phenomenon and excessive eyelid squeezing, the globe is rotated upwards and moves backwards into the orbit between 0.7 to 1.7 mm.4 An occlusion or rupture of short ciliary arteries may result caused by sudden retroplacement of the globe into the orbit,4 which leads to the typical choroidal infarction of the corresponding vascular choroidal segments.3,4 We found Hutchinson-Siegrist-Neubauer syndrome in 1% of all contusions of the Erlangen Ocular Contusion Registry.5

Our theory is supported with the recommendation of Vinger, who discussed the need for appropriate protective eyewear for all patients who had undergone intraocular surgery, especially in high risk patients—that is, after ICCE surgery.9

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