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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 60  |  Issue : 2  |  Page : 198-199

Dissimilar Maculopathies after Electrical Shock Injury: A Rare Case Report


1 Department of Medical Retina, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
3 Department of Vitreoretina, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission02-Oct-2020
Date of Acceptance18-Jan-2022
Date of Web Publication30-Jun-2022

Correspondence Address:
Saurabh Deshmukh
Sri Sankaradeva Nethralaya, 96, Basistha Road, Guwahati - 781 028, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_147_20

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  Abstract 


High electrical current can cause serious ocular injuries resulting in permanent vision loss, besides life-threatening complications. A 56-year-old man presented with diminution of vision in both eyes. The past medical history revealed occupational exposure to high-voltage electrical current 10 years ago. Fundus showed a foveal scar in the left eye and a dull foveal reflex in the right eye. Optical coherence tomography revealed foveal thinning in the right eye and foveal scarring in the left eye. This report thus highlights a case of dissimilar electric shock maculopathies depending on the distance of the eye from the point of entry of electric current.

Keywords: Electric injury, electric maculopathy, retinochoroidal atrophy


How to cite this article:
Deka H, Godani K, Deshmukh S, Barman M, Soibam R. Dissimilar Maculopathies after Electrical Shock Injury: A Rare Case Report. TNOA J Ophthalmic Sci Res 2022;60:198-9

How to cite this URL:
Deka H, Godani K, Deshmukh S, Barman M, Soibam R. Dissimilar Maculopathies after Electrical Shock Injury: A Rare Case Report. TNOA J Ophthalmic Sci Res [serial online] 2022 [cited 2022 Aug 10];60:198-9. Available from: https://www.tnoajosr.com/text.asp?2022/60/2/198/349506




  Introduction Top


Electrocution or electric burns account for 5%–20% of all causes of burns. It can be caused by low-voltage or high-voltage currents. The intensity of electric burn depends on the tissue resistance, current flow, and voltage.[1] Although ocular complications caused by high-voltage electrical burns are rare, the most common ocular manifestations are the eyelids burns and the development of cataract. Other rare ocular complications resulting from electric shock injuries are recurrent uveitis, optic neuropathy, and maculopathies.[2] The retina and optic nerve because of their low resistance to electrical current, often escape direct injury. However, the higher tissue impedance of retinal, choroidal, and optic nerve circulations can lead to secondary changes in the retina.[3] Isolated electric shock-associated maculopathy has been rarely reported in the literature. This case report documents different grades of electric shock maculopathies in different eyes of the patient. Furthermore, this case report highlights that the grade of maculopathy depends on the distance between the point of entry of electricity and the eyes.


  Case Report Top


A 56-year-old male patient presented with diminution of vision in both eyes for 1 year. He gave a history of electric shock 10 years back following which there has been a gradual diminution of vision in both eyes. Electrocution resulted from occupational accident, and the approximate voltage of the current was 11,000 volts. Systemic examination revealed burns on the left hand, forearm and arm and on the chest. His best-corrected visual acuity was 6/24, N10 in the right eye and counting fingers at 3 m in the left eye. Anterior segment examination was unremarkable. Intraocular pressure was within normal limits for both eyes. Fundus examination showed dull foveal reflex in the right eye [Figure 1]a. The left eye fundus examination showed the presence of a scar at the macula [Figure 1]b. Optical coherence tomography scan of the right eye showed foveal thinning with loss of outer retinal layers, and the left eye showed area of foveal scarring with chorioretinal atrophy [Figure 1]c and [Figure 1]d. Fundus fluorescein angiography showing patchy hyperfluorescence due to window defect [Figure 1]e and [Figure 1]f. Hence, a diagnosis of electric shock maculopathy in both eyes was made. The patient was prescribed low vision aid for near and was kept on follow-up. At 1 year of follow-up, the visual acuity remained the same.
Figure 1: Fundus photograph of the (a) right eye showing dull foveal reflex and the (b) left eye showing macular scar. Optical coherence tomography scan of the (c) right eye showing foveal thinning with loss of outer retinal layers and (d) left eye showing foveal scarring with chorioretinal atrophy. Fundus fluorescein angiography of both eyes (e and f) showing patchy hyperfluorescence

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  Discussion Top


Electric shock maculopathy is a rare clinical entity and has been infrequently reported in the literature. The most commonly reported posterior segment finding in an electric shock injury is the disruption of retinal pigment epithelium (RPE) and the outer retinal layers to form outer lamellar hole with intact internal limiting membrane over the bare RPE. A full-thickness macular hole has been rarely reported. This represents an extensive and severe form of electric shock maculopathy.[4],[5],[6] The severity of tissue damage from electric shock is determined by tissue resistance, and the proximity of the route travelled by the electrical current.[7] In our case, the point of entry of electricity was the left hand; thus, the proximity of the left eye predisposed it to maximum damage. The damage in the right eye was less as the right eye was further away from the point of entry of electricity.

Various mechanisms causing tissue damage include direct transmission of electric current through the tissues causing cell membrane disruption, thermal burn of the tissues resulting from conversion of electrical energy into heat, tissue ischemia caused by generalized vascular constriction, or mechanical injury resulting from high-voltage shock wave.[8] The most vulnerable components of the posterior segment of the eye to gratuitous electrical energy are the retinal, choroidal, and optic nerve circulations. The low-resistant retina and optic nerve appear relatively immune to direct electrical current injury, and damage to these structures typically follows retinal and choroidal vascular occlusion. Where the electrical injury is less severe, macular pigmentary changes, photoreceptor alterations may occur.[3],[9] Various factors which make macula most susceptible to electric shock injury-related changes. Foveal avascularity increases the risk of ischemic injury of macula following electric shock-induced choroidal ischemia. The macula is more sensitive to thermal damage as the macular RPE has a high concentration of melanin granules which increase the resistance, resulting in greater thermal denaturation.[8] This case report thus documents the occurrence of dissimilar maculopathies in the two eyes of a case of electric shock injury.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to thank Sri Kanchi Sankara Health and Educational Foundation, Guwahati, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mohan A, Srinivasan K, Ashokan B. Clinico-etiological profile and outcome of electric burns at RLJH, a tertiary care centre of south India. Indian J Burns 2014;22:79-82.  Back to cited text no. 1
  [Full text]  
2.
Boozalis GT, Purdue GF, Hunt JL, McCulley JP. Ocular changes from electrical burn injuries. A literature review and report of cases. J Burn Care Rehabil 1991;12:458-62.  Back to cited text no. 2
    
3.
Al Rabiah SM, Archer DB, Millar R, Collins AD, Shepherd WF. Electrical injury of the eye. Int Ophthalmol 1987;11:31-40.  Back to cited text no. 3
    
4.
Miller BK, Goldstein MH, Monshizadeh R, Tabandeh H, Bhatti MT. Ocular manifestations of electrical injury: A case report and review of the literature. CLAO J 2002;28:224-7.  Back to cited text no. 4
    
5.
Sony P, Venkatesh P, Tewari HK, Garg SP. Bilateral macular cysts following electric burn. Clin Exp Ophthalmol 2005;33:78-80.  Back to cited text no. 5
    
6.
Faustino LD, Oliveira RA, Oliveira AF, Rodrigues EB, Moraes NS, Ferreira LM. Bilateral maculopathy following electrical burn: Case report. Sao Paulo Med J 2014;132:372-6.  Back to cited text no. 6
    
7.
Ouyang P, Karapetyan A, Cui J, Duan X. Bilateral impending macular holes after a high-voltage electrical shock injury and its surgical outcome: A case report. J Med Case Rep 2014;8:399.  Back to cited text no. 7
    
8.
Ranjan R, Manayath GJ, Dsouza P, Narendran V. Spontaneous anatomical and functional recovery of bilateral electric shock maculopathy. Indian J Ophthalmol 2017;65:1256-61.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Grover S, Goodwin J. Lightning and electrical injuries: Neuro-ophthalmologic aspects. Semin Neurol 1995;15:335-41.  Back to cited text no. 9
    


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