A Case of Retinal Pigmentary Changes Associated with Retained Bullet Fragments

Title A Case of Retinal Pigmentary Changes Associated with Retained Bullet Fragments
Author, Co-Author Leon Nehmad, Melanie Crandall, Hua Bi, Albert Woods
Topic
Year
2014
Day
Friday
Program Number
145304
Room
Four Seasons Ballroom
Affiliation
State University of New York
Abstract Background: Lead toxicity has been demonstrated to affect retinal function, with rods being preferentially involved. Cases of retinopathy resulting from lead poisoning have been infrequently reported, with those attributable to bullet wounds to an even lesser extent.

Case report: A 48 year-old black male presented with a complaint of reduced vision, OD worse than OS for the past 6 months. He works as truck driver and reported that his symptoms were worse when driving at night. He suffered a gunshot wound to the chest 3 years prior, resulting in retained bullet fragments. Ocular history was unremarkable for self and family as was systemic history except for controlled hypertension. Best corrected acuity was 20/20 in each eye. Confrontation visual fields revealed an inferior temporal constriction OD and were full to finger count OS. There were diffuse and focal retinal pigmentary changes OD>OS in the posterior poles, that were more marked in the areas around the optic nerves and along the vascular arcades. The changes appeared to have increased at a 3-month follow up visit. Flash/full-field ERG showed significant attenuation and delay in the scotopic, and to a lesser extent photopic responses for both eyes, with the right eye impacted to a greater degree than the left, consistent with the patient’s visual symptoms and fundus appearance. The patient was referred to his primary care physician for evaluation of possible toxic lead levels resulting from the retained bullet fragments. Follow up ocular testing includes monitoring with threshold visual fields as well as multifocal ERG.

Conclusions: Bilateral, asymmetric retinal pigmentary changes with ERG abnormalities may occur in patients with retained bullet fragments due to lead toxicity. A full ocular and systemic evaluation including electrodiagnositc testing and toxicology levels is indicated as part of the diagnostic work up in differentiating this etiology from hereditary retinal dystrophies.
Affiliation of Co-Authors Nova Southeastern University, College of Optomety, Nova Southeastern University, Nova Southeastern University, College of Optometry
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