Post-traumatic bilateral blindness in a toddler

Abstract

A unique case of vision loss in a two-year-old boy after sustaining a head injury as a pedestrian versus car was seen at our paediatric trauma unit. A CT brain was negative for fracture, intra-cranial haemorrhage and contusion. There were no neurological symptoms and no signs of abuse. Ophthalmological examination demonstrated retinal haemorrhages, cotton wool spots and Purtscher flecken that are pathognomonic for the diagnosis of Purtscher's retinopathy. This occlusive microvasculopathy, associated with cranial and chest trauma, may cause severe blindness. In literature, bilaterality was described in almost two thirds of cases. Regardless of management with or without medication, visual function improved in the majority of cases. In our case, despite treatment with high-dose intravenous methylprednisolone, the child's vision remained poor with bilateral optic atrophy and retinal pigmentary changes. Children with Purtscher's retinopathy should be examined for signs of non-accidental injury. Keywords: paediatric trauma, Eye trauma, Blindness, Retinopathy