We report here our studies on a group of patients with indirect choroidal ruptures, noting the circumstances of the injury, the extent of ocular damage, cause ofany visual loss, and longterm visual outcome. We suggest a working hypothesis to account for the mechanism of production of indirect choroidal ruptures and pose the question of a possible role of minor trauma in presumed non-traumatic maculopathies.The average age at the time of the injury was 24 years (range 8-45 years). The average follow-up time after injury was 4/2 years (range 6 months to 41 years, though in only two cases had the injury occurred more than 10 years previously).All the patients gave a detailed history of the original injury and then had a full ophthalmic assessment -including computerised visual fields, retinal photography, fluorescein angiography, electroretinography, and measurement of pattern reversal visual evoked potentials.Individual fundal photographs were projected on to a screen, enabling the outlines of each rupture to be marked. By this method composite patterns of rupture following different types of injury were produced. For ease of comparison all slides were projected to produce the image of a left fundus -that is, photographs of right fundal lesions were inverted.
ResultsFrom the patients' histories we could identify three groups of circumstances in which the injury occurred -namely, sport, assaults, and accidents at work. Eight of 11 injuries due to sport occurred in males aged 1-15 years, and in 9/11 cases the left eye was injured (005> p>0 02). Nine of 13 of the injuries following assaults occurred in males aged 15-31 years; in 8/ 13 cases the left eye was injured (not a significant difference). Accidents at work accounted for six cases, four of these patients being over 30 years old; in 2/6 cases the left eye was affected (not a significant difference).The type of injury was divisible into two groups -those due to punches, where the eye was subjected to a diffuse force, and those due to projectiles, which had a more focal impact on the globe. The distribution of ruptures in seven eyes subjected to punches is shown in Figure 1 and can be seen to be mainly restricted to the peripapillary region. These ruptures were Sunderland Eye Infirmary, Queen