Sir,

Retinal pigment epithelium (RPE) tear mostly occurs as a complication of age-related macular degeneration but may also develop as a rare complication after trauma.1, 2, 3, 4, 5 Patients with traumatic RPE tear involving the fovea usually have poor visual prognosis.1, 2 We report the spontaneous resolution of traumatic RPE tears and pigment epithelial detachment (PED) in a patient after blunt trauma who subsequently had good visual recovery.

Case report

A 63-year-old woman presented with left blurred vision after being hit by a badminton racquet. Her left eye visual acuity was 20/30 and fundus examination revealed a 1.5 disc-diameter PED involving the fovea and a crescent-shaped lesion at the RPE level temporal to the fovea. Fluorescein angiography showed two areas of window defects due to RPE loss (Figure 1) and optical coherence tomography (OCT) revealed two areas of RPE discontinuation within the PED (Figure 2a). No rolling or retraction of the RPE was detected. She was managed conservatively and serial OCT showed progressive apposition of the torn RPE layer with reduction in PED (Figure 2b and c). Six months later, her visual acuity recovered to 20/20 and OCT showed complete resolution of the PED and restoration of the normal retinal layers (Figure 2d).

Figure 1
figure 1

Mid-phase fluorescein angiography of the left eye showing PED with linear areas of hyperfluorescence at the macula owing to traumatic RPE tears.

Figure 2
figure 2

Serial OCT of the left eye. (a) At the time of presentation, two RPE tears were detected with one under the fovea (arrowhead) and one at the edge of the PED (arrow). (b) OCT at 2 weeks postinjury, (c) at 6 weeks postinjury, and (d) at 6 months postinjury showing gradual resolution of the traumatic RPE tears and PED.

Comment

RPE tear occurs rarely after blunt trauma as the force causing the RPE tear falls in a very small window.4 The force must be large enough to cause RPE tear but not too large in causing both RPE and Bruch's membrane tears as in choroidal rupture. As the elastic RPE tends to retract over the intact RPE, RPE tear is usually prevented from healing and visual recovery is generally poor. In our patient, OCT demonstrated no RPE retraction or rolling and spontaneous healing of the RPE tears could occur. This might be due to the development of two traumatic RPE tears, which have reduced the forces causing RPE retraction. Despite the PED and one of the traumatic RPE tears involving the fovea, her visual acuity recovered to 20/20. Our case illustrated that in the absence of RPE retraction, traumatic RPE tears may heal spontaneously and patients may have good final visual outcome.