Certain systemic injuries, even if the eye is not directly involved, may indirectly cause ocular pathologies, usually by one of the following mechanisms:

• Changes in rheologic conditions

• A sudden increase of the intravascular pressure.

Because of a great variety of retinal findings and a still somewhat vaguely understood retinal response, the pathomechanisms are not completely understood. The retinal findings may be caused by:

• Embolic damage (e.g., air, blood products, fat)

• Increased intraluminal pressure with endothelial vascular damage

• Mechanical forces acting at the vitreoretinal interface

O Pearl

All physicians, and especially those working in the ER, should know that bodily trauma can cause sight-threatening ocular complications even in the absence of direct eye involvement.

Patient complaints about visual loss whether voiced hours or months after the trauma, should result in an instant referral to an ophthalmologist. If the patient is unconscious or mentally incompetent, ophthalmological examination should be initiated to rule out a direct or indirect traumatic retinopathy. The findings should be meticulously documented for medical and legal purposes (see Chap. 1.8).

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