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   Table of Contents      
PHOTO ESSAY
Year : 2016  |  Volume : 64  |  Issue : 2  |  Page : 151-152

Lightning injury of posterior segment of the eye


Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, Tamil Nadu, India

Date of Submission21-Jul-2015
Date of Acceptance23-Dec-2015
Date of Web Publication5-Apr-2016

Correspondence Address:
Dr. Ekta Rishi
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, 18 College Road, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.179724

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  Abstract 


Keywords: Cystoid macular edema, lightning injuries of eye, lightning maculopathy, macular hole


How to cite this article:
Rishi E, Indu V P, Rishi P. Lightning injury of posterior segment of the eye. Indian J Ophthalmol 2016;64:151-2

How to cite this URL:
Rishi E, Indu V P, Rishi P. Lightning injury of posterior segment of the eye. Indian J Ophthalmol [serial online] 2016 [cited 2019 Dec 12];64:151-2. Available from: http://www.ijo.in/text.asp?2016/64/2/151/179724


  Case Report Top


A 40-year-old male was struck by lightning resulting in loss of consciousness. Ten months later, he presented with complaints of metamorphopsia in the left eye. The best-corrected visual acuity was 6/6, N6 in the right eye and 6/7.5, N6 in the left eye. Anterior segment examination was normal. Fundus examination of the left eye revealed a lamellar hole at macula and a group of pigment clumps arranged in a wedge-shaped pattern in the temporal periphery of retina [Figure 1]. Fundus fluorescein angiogram of the left eye revealed retinal pigment epithelium (RPE) window defects at fovea and blocked fluorescence in the temporal periphery due to pigments, better seen on red-free photograph [Figure 2] and [Figure 3]. Spectral domain optical coherence tomography (SD-OCT) analysis of the left eye demonstrated a lamellar hole with intraretinal cystic spaces and a defect in the inner segment/outer segment (IS-OS) junction [Figure 4]. Fundus examination and imaging studies in the right eye were normal.
Figure 1: (a) Color fundus picture of the right eye, (b) color fundus picture of the left eye of the same patient with retinal pigment epithelial alterations at fovea after lightening injury

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Figure 2: (a) Fundus fluorescein angiogram of the right eye, (b) fundus fluorescein angiography picture of the left eye shows retinal pigment epithelial window defects at macula following lightening injury

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Figure 3: Red-free fundus image of the left eye showing pigment clumps in temporal periphery after lightening injury

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Figure 4: (a) Optical coherence tomography images of macula of the right eye, (b) optical coherence tomography image of the left eye of the same patient with a lamellar macular hole following lightening injury

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  Discussion Top


Lightning-induced maculopathy is caused by the heat generated at the level of RPE due to resistance by melanin.[1] It often manifests as cystoid macular edema and macular hole.[2],[3]

SD-OCT analysis shows loss of foveal photoreceptors and IS-OS junction disruption.[4] Peripheral pigmentary changes following lightning injury as seen in our patient have also been described in the literature.[4] Visual prognosis in patients with lightning-induced ocular injury depends on the extent of irreversible retinal and macular damage. Therefore, long-term follow-up of these patients is recommended.

Acknowledgment

We would like to acknowledge photography and OCT services at Sankara Nethralya, Chennai.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Lagrèze WD, Bömer TG, Aiello LP. Lightning-induced ocular injury. Arch Ophthalmol 1995;113:1076-7.  Back to cited text no. 1
    
2.
Handa JT, Jaffe GJ. Lightning maculopathy. A case report. Retina 1994;14:169-72.  Back to cited text no. 2
    
3.
Rao KA, Rao LG, Kamath AN, Jain V. Bilateral macular hole secondary to remote lightning strike. Indian J Ophthalmol 2009;57:470-2.  Back to cited text no. 3
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4.
Armstrong B, Fecarotta C, Ho AC, Baskin DE. Evolution of severe lightning maculopathy visualized with spectral domain optical coherence tomography. Ophthalmic Surg Lasers Imaging 2010;41 Suppl:S70-3.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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