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Blunt Eye Trauma

Blunt Eye Trauma

30 August 2017

Blunt Eye Trauma

On the 9th of July 2017, at around 9:30am, I was getting ready to go to Capoeira when I tripped and landed face first, more unfortunately, eye first, on the metal baby gate on top of the stairs.

The pain was intense and I collapsed on the floor screaming. I put my hand over my right eye, the source of the pain, then looked at my hand. The first thing I noticed was the blood and then I realised I couldn’t see out of my right eye at all.

I went into the bathroom and I had this awful feeling of being in a horror movie. There was blood running down from my eyebrow into my eye. So I washed the whole area and realised the blood was from a vertical cut to my eyebrow. After I washed everything I still couldn’t see at all from that eye. It was like someone put a glass lens in my eye and smeared with vaseline. I could only see light/dark shapes. By then my husband had come upstairs because of all the screaming. He got me some ice to put on the eye area and said we had to go to hospital a.s.a.p.

I think I was in shock, I felt strangely calm even though I seriously thought the possibility of losing sight on my right eye to be very real.  It took me about half an hour to get myself together and finish my coffee and then we left the house.

My husband dropped me off at A&E at St. George’s, our nearest hospital, and went to park the car. It was around 10am, Sunday morning. The room seemed full of people. I walked in, ice pack on my face, and they sent me straight through to triage. My husband joined me. The nurse glued my eyebrow together, did some basic eye tests, I really couldn’t see at all.  Then she sent us to the 5th floor. Moorfields Eye Clinic. I was a patient of Moorfields, Old Street, for a number of years, because I suffer from Keratokonus. They discharged me years ago as it stabilised (i.e. cornea stiffens with age).  Here I was, back again.

We were on the 5th floor for just over an hour. I was icing the eye constantly, which helped with the pain. Well, basically, I wasn’t in pain. HAIL THE ICE! First a nurse saw me, did some more tests. While I was there the vision started to come back, about 10% better. I was seeing shapes more clearly and when she tested my vision with pinhole glasses I could actually read some of the letters on the eye chart! I asked her if that meant I wasn’t going to go blind, she said ‘no’. I asked you mean I won’t go blind, or it doesn’t mean I won’t go blind? She said ‘no’ again. So clear as mud. She asked me what the nurse downstairs put on my eye, I said I had no idea. Didn’t she write it down? No, she hadn’t. wasn’t on the notes. BREATHE.  I could feel myself getting annoyed, so I just breathed.

She dilated my pupils and then we waited a bit longer to see the ophthalmologist.
After about 45 minutes I get called in, by then the opacity was less, probably 30% vision back. She looked at my eyes and said it was weird, seems I have https://en.wikipedia.org/wiki/Uveitis (Uveitis -> Iritis is Anterior Uveitis ) on BOTH eyes, she’d only expect it on one, the right eye. She asked if we have a cat (because of toxoplasmosis), if I was sensitive to light (which I am a bit, considering my brown eyes, but I always put that down to Keratoconus). She said it could just be that, although I didn’t get hit directly on the left eye, it also suffered from the impact.

Another cause could be Syphilis and long list of lovely diseases 🙁 She also asked if I had a rash, or moles, I have a few come up recently and showed her the latest but also explained my aunt is 70 and had LOTS of them and is fine.  She didn’t seem concerned about the moles either.

Got home around 13:00 and vision was even less opaque, about 60%, but eyes were extremely sensitive to light because of drops. Got prescribed steroids for both eyes and pupil dilator for right eye – like valium for the eye, to keep it relaxed. She said for me to go back tomorrow morning, but I decided to go on Tuesday, give it an extra day to settle down – she also said Mondays were busy and I didn’t fancy two days in a row in hospital.

Prescription – Dexamethasone 0.1% eye drops (right eye every two hours, left eye every 4 hours)
Cyclopentolate 1% eye drops to dilate pupil.

Spent rest of the day doing NOTHING, so boring, watched tv but wasn’t able to see clearly. Reading is quite difficult but manageable. Was icing the eye until bedtime but also worried that might be stopping healing from starting.  My husband patiently took care of me.

I was told not to exercise or pick up anything heavy, so I couldn’t look after my granddaughter the next day. I usually look after her on Mondays/Thursdays.

On Tuesday 11 July, I went to the main Moorfield’s clinic on ground floor. Got seen quite quickly as I went in as an emergency patient. Was told to reduce drops on left eye to twice a day for two days, then once a day for two days, then stop. Right eye, once a day only for pupil dilation in evening. Right eye six times a day for steroids.

STILL CAN’T EXERCISE until further notice!!!!! Vision was very blurred, not possible to drive.

I was invited back on the 17th of July and was told to keep doing the steroid drops and taper it slowly over the next 3 weeks. As the eye pressure was high (due to steroid drops, probably) I was given drops to control the pressure.

Maxidex 0.1% w/v
1 week on 4 drops a day for steroids
1 week on 3 drops a day
1 week on 2 drops a day

Iopidine 5mg/ml
14 days on 3 drops a day on eye pressure control
14 days on 2 drops a day

STOP dilating right eye pupil

Come back in three weeks…

Was also told I can exercise again.  Dr. said there may be long term damage, only time can tell, but exercise won’t affect it anymore. I might end up with pupil always dilated, and vision impairment as there’s a little hole on the right side of the eye. There’s still a bit of blood at the bottom of eyeball too. He thinks that will clear. The thing is I was going to Greece for Capoeira event on the last weekend of July. I wanted to cancel the trip, but when I tried to I was told I’d probably not get a refund, just a transferable flight. The Dr. didn’t see any reason I shouldn’t go.  So I decided to go.

After a bit of searching, this seems to make the most sense

You have perhaps 20% chance of the pupil ending up larger than the other eye. That is called traumatic iridoplegia. It may be up to 6 months before it can be said to be permanent. If troublesome you can use mild drops to keep the pupil small or at least more the size of the other. There is nothing that will restore perfect pupil function if it doesn’t recover on its own.

http://www.iritis.org/phpBB3/

Mydriasis is damage to the iris sphincter muscle, resulting in pupil dilation all the time. traumatic iris mydriasis

This is the letter written by the specialist after the apt. on the 17th and sent to me and GP.

I reviewed this patient today. The right eye is comfortable but still blurred. On examination vision was 6/36 with her glasses, 6/9 pinhole. There is some persisting anterior uveitis and mydriasis. The latter is in part due to cyclopentolate drops she is using once a day which I have now asked her to stop. However there is a notch on the pupil margin suggesting that some sphincter damage has been sustained. We will be better able to gauge any effect of this on pupil function next time. The eye pressure was slightly up today which may well be a response to the steroid drops or to the inflammation. However we will check for angle recession next time. In the meantime I have prescribed Aproclonidine drops used to keep the pressures down while she continues to gradually reduce the steroid drops over the next four weeks.

We will see her again in 3 weeks.

Did a bit of research and found this out:

6/36 means I can see from 6m what normal vision can see from 36m, with my glasses 🙁 Really bad. For driving it has to be 6/12 minimum.

http://www.webmd.boots.com/eye-health/guide/visual-acuity

If you can only read the big letter on the top line, that’s recorded as 6/60 – you can see at 6m what can usually be seen from 60m with normal vision.

If you can identify 2 letters from the second row, that’s 6/36

Three letters from the third row is 6/24

This continues down to the seventh row, where around 7 letters corresponds to 6/6 vision.

I got an apt. not in 3 weeks, but 5 weeks later, 21st of August. Greece was ok, but I had to rely on other people to get around, as reading signs was particularly difficult. On the last night in Greece my vision started to go opaque in the evening and I got really worried. It sort of ruined the last night. I was in the process of tapering down the drops and was worried something had gone wrong and inflammation was getting worse. Whatever caused it, I was fine the next day, the vision wasn’t opaque anymore. Maybe it was just tiredness, there had been a lot of capoeira, beer and not much sleep.

When it came to the apt. day, I had stopped the drops two weeks earlier. On one particular day, 4th of August, my vision went very weird. It was going very grey and foggy on right eye for a few of seconds whenever I stood up. It was so bad I’d have to stop and wait until it cleared so I could continue going where I was going. I was tempted to stop putting the drops. At least the one to lower eye pressure. There were only three days left till I was supposed to stop… There was a very faint, dull ache on the left hand side, back of my head, not sure if it was related. Might have been the start of the cold I had a few days later…

https://www.drugs.com/sfx/maxidex-side-effects.html
seeing a veil or curtain across part of your vision
seeing flashes or sparks of light
seeing floating spots before the eyes
blurred vision? (could be from injury rather than drops)

I stopped the eye pressure drops the next day because I felt the weird side effects were being caused by low eye pressure. I continued with the steroid drops for one more day and then no more drops. And then I got a cold the day after 🙁 The foggy vision only lasted for another day. I tried to carry on as normal as I could and was still training Capoeira.

I did a video with the photos I had been taking from day 1 till day 25.

Over the next couple of weeks, until the next apt. I noted the eye progress on my calendar. The bruise cleared exactly a month after the impact on August 9th. The right pupil was still always dilated but smaller. Then it started to respond to light/dark, but very slowly, and never getting as small as the left eye.

On the 13th of August I wrote on my calendar:

Out with granddaughter and husband and realised I can see further with my right eye! But because pupil is still dilated the colours are more vivid too. I can read road signs, number plates and bus numbers

On the 21st I had my final apt, and I was discharged, here’s the letter

I reviewed patient today. Unfortunately, the right pupil remains dilated and poorly reactive with some notching of the margin following the trauma she had about 8 weeks ago. It does react but very poorly. However, there does not appear to be any definitive angle damage on gonioscopy and pressures have returned to normal in both eyes. The retina looks fine as before.

It may well be that the degree of pupil dilation will reduce with the passage of time but I suspect there will always be a degree of asychoria and poor reaction on the right hand side. In the longer term she has an increased risk of problems with the pressure in the eye and should make sure that this is checked on a regular basis, every couple of years or so at the opticians in the normal way.

I do not think we need to keep her under review as she has not had any reactive pathology and is not on any treatment but we would be happy to see her again n the future should problems arise

Mr Colin Carter FRCOphth

I never had a Gonioscopy before. First he put some anaesthetic drops in my eye, which stung a lot, then he seemed to basically shove a lens on the right eye, then the left. It was a bit of a disturbing procedure. Kept thinking of a Clockwork Orange wide eye scene!  I actually had to control my breathing at first as I could feel myself panicking.  When it came to placing the lens in position on my left eye, it actually took 3 attempts!!!

Gonioscopy feels a bit like this.

 

This is what Gonioscopy looks like in reality…

So, my vision feels like it’s back to normal.  With the pupil not responding so well, I’m still light sensitive but I don’t need sunglasses to go outside on a cloudy day anymore.  Only time will tell if the pupil will be fully functional again.  Dr. thinks not, I hope yes.  When I wear my contact lenses I can finally see people’s faces from 6-7 m – this was essentially my test during training, at first I couldn’t see my friend’s faces from that distance, just blurry blobs.  Now I can actually see their faces more clearly, like before.  Because of my myopia and astigmatism I could never get 6/6 vision, as my contact lenses don’t cover my 4.5 astigmatism on left eye.  I can only get up to 2.75.  Which is good enough for exercising.

I have an eye test on the 2nd of September, I just want to see how much prescription has changed.  It has been nearly 3 years since my last eye test so I’m due another one.  If there’s no much difference I think I’ll wait another 6 months once it’s all fully healed, then have another test and then get new lenses.

phew!  Epic.  The end.

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