A 31 y.o. comes from prison with vision loss; he was hit in the L eye playing softball.

He has  a hyphema but also the fundus appears below.  What is the white patch?

Our patient had Berlin’s edema of the eye.  This whitish patch is caused by shock waves traversing the eye from the site of impact after blunt trauma.  It was first described by Berlin in 1873.  It occurs hours after injury and it thought to be caused by extracellular edema .  A cherry-red spot may also appear on the fovea because cells involved with the whitening are not present in the fovea.  Visual acuity may decrease to 20/200 but usually resolves in 3-4 weeks.

traumatic lens dislocation

An estimated 30% of eye injuries presenting to the ED will have Berlin’s edema.  Blunt trauma to the eye also may result in hyphema, lens dislocation, vitreous hemorrhage, retinal breaks and detachment, and early and late glaucoma. Macrophages filled with hemoglobin or degenerated erythrocytes  raise the intraocular pressure by obstructing the trabecular meshwork after a vitreous hemorrhage. The increase in ocular pressure can occur immediately after an eye injury or years later. Two peaks of glaucoma have been reported , less than one year and greater than 10 years after trauma. 3.4% of patients with eye injuries develop glaucoma.

Our patient had both Berlin’s edema and a visible traumatic hyphema. He had normal eye pressure.  He was treated with  cyclopentolate 1% and prednisolone 1%.  His vision gradually improved.

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