Severe Eye Injury: Insights on Vision Loss and Treatment Options

Before and after the suturing surgery for the left eye globe laceration, there was no light perception in the left eye?

Description: 28 days ago, I suffered a traumatic injury to my left eye and was taken to Kaohsiung Veterans General Hospital for ocular globe suturing surgery.
Both before and after the surgery, there was no light perception in the left eye.
The diagnosis was a ruptured globe in the left eye, with hyphema and vitreous hemorrhage.
The attending physician informed me that the globe rupture was severe (with nearly 180 degrees of laceration requiring about 10 sutures) and that there was no possibility of vision recovery.
I was hospitalized for 3 days and upon discharge, I was instructed to use CRAVIT (ophthalmic solution) and prednisolone acetate ophthalmic suspension USP in the left eye every 2 hours.
However, 14 days post-discharge, I went to Kaohsiung Armed Forces General Hospital for an electroretinogram and visual field tests.
The attending physician informed me that the optic nerve was within normal limits, but both the sclera and retina of the left eye were damaged, and that vision recovery was not possible.
During this period, I was taking medication, including compesolo 5mg and tranexamic acid 250mg (four times a day).

As I work in the computer and internet industry, I have a high visual workload (at least 6-8 hours a day), and I am concerned that relying on my right eye may place additional strain on it.
Therefore, I would like to ask Dr.
Tsai a few questions for clarification:
1.
Currently, the white part of my left eye appears congested, and I cannot see the pupil.
At Kaohsiung Armed Forces General Hospital, I inquired whether there was a need to rule out intraocular hemorrhage, but Kaohsiung Veterans General Hospital did not provide any related treatment.
Will intraocular hemorrhage resolve over time, or is more aggressive treatment necessary?
2.
When the light changes (for example, moving from outdoors to indoors where the light suddenly shifts from bright to dark), the thick white haze in my left eye temporarily becomes a thin white haze for about 10 seconds, as if I am using both eyes to view an object.
When I shift my gaze to the far left, I can see a blurry image (for instance, when sitting in the front passenger seat and looking hard to the left, I can perceive the driver through peripheral vision, but in bright outdoor light, the left peripheral vision completely disappears behind the thick white haze).
Additionally, I occasionally feel that the thick white haze temporarily turns into a thin white haze whenever there is a change in lighting.
What could be the cause of this?
3.
Both hospitals have reported normal intraocular pressure.
I would appreciate your insights on these issues or if there are any more aggressive treatment options available.
Thank you!

Chris Tou, 40~49 year old female. Ask Date: 2017/04/25

Dr. Cai Wenyuan reply Ophthalmology

Hello, I apologize for the lengthy response, but my ability to assist you is limited.
Based on your description, I do not have any other good suggestions.
Kaohsiung Veterans General Hospital is quite large, and it may be sufficient for you to seek medical care locally.
Wishing you peace and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Ophthalmology Department, Ministry of Health and Welfare Taoyuan Hospital.

Reply Date: 2017/04/25

More Info

I'm sorry to hear about your severe eye injury and the challenges you're facing with your vision. Eye injuries can be complex and often lead to a range of complications, including vision loss, discomfort, and changes in visual perception. Let’s address your concerns one by one.

1. Internal Hemorrhage in the Eye: After an eye injury, it is not uncommon for blood to accumulate within the eye, a condition known as hyphema or vitreous hemorrhage. The body can sometimes reabsorb this blood over time, but the duration and effectiveness of this process can vary significantly from person to person. In some cases, if the blood does not clear on its own or if it leads to increased intraocular pressure or other complications, more aggressive treatments may be necessary. This could include surgical intervention to remove the blood or to address any underlying issues that may be causing the bleeding. It's crucial to maintain regular follow-ups with your ophthalmologist to monitor the situation closely.

2. Changes in Visual Perception: The phenomenon you describe, where your vision changes from a thick white haze to a thinner one under different lighting conditions, could be related to several factors. One possibility is that the injury has affected the clarity of your cornea or the lens of your eye, leading to fluctuations in how light is processed. Additionally, the presence of any residual blood or inflammation can also contribute to these changes in visual perception. The fact that you can see some shapes or outlines suggests that there may still be some functional vision remaining, but the quality is compromised. This is often a result of the injury affecting the pathways that transmit visual information to the brain.

3. Intraocular Pressure: It’s reassuring that both hospitals have reported normal intraocular pressure, as elevated pressure can lead to further complications, such as glaucoma. However, it’s essential to continue monitoring this, especially after significant trauma. Regular eye exams will help ensure that any changes in pressure are caught early.

In terms of treatment options, while your current medications (CRAVIT and prednisolone) are aimed at reducing inflammation and preventing infection, you might want to discuss with your doctor the possibility of additional therapies. Some patients benefit from corticosteroids to manage inflammation, while others may require more specialized treatments depending on the specifics of their injury.
Additionally, given your extensive computer use, it’s crucial to take breaks and practice good eye hygiene to reduce strain on your right eye. Consider using artificial tears to keep your eyes lubricated and reduce discomfort.
Lastly, regarding your concern about the long-term prognosis, it’s important to have realistic expectations. While some patients do experience improvement over time, others may not regain significant vision, especially in cases of severe trauma. Engaging in supportive therapies, such as vision rehabilitation, can help you adapt to changes in your vision and maximize your remaining sight.

In conclusion, I recommend maintaining close communication with your ophthalmologist, adhering to follow-up appointments, and discussing any new symptoms or concerns as they arise. They can provide the most tailored advice based on your specific condition and needs. Your situation is undoubtedly challenging, but with the right care and support, you can find ways to manage your vision and maintain your quality of life.

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