Retinal Detachment

A Boxing Match Left President T. Roosevelt with Blindness due to This Condition • Xray of the Week

This 47 year old female presented with left visual field defect. What is the diagnosis?

Figure 1. A: Ultrasound of the normal right globe.

Figure 1. B: Ultrasound of the left globe, demonstrating an irregular echogenic region posteriorly due to the detached retina. Notice the tenting, due to retinal tissue adherent to the optic disc. There are adjacent subtle echoes representing vitreous hemorrhage.

Figure 2. A different patient with a large retinal detachment of the right globe.

Figure 3. Another patient with retinal detachment, neglected for 3 days, now with associated severe hemorrhage.

Figure 4. There are many treatments for retinal detachment; however, scleral banding (or scleral buckling) as seen in this patient's left eye is one of the methods commonly used by ophthalmologists. Note the high attenuation surgical foreign body which surrounds the left orbit, causing an elongation of the globe. The detached retina has healed and is not visualized.

Figure 5. Diagram of scleral buckle.

Causes of retinal detachment include diabetes, myopia, trauma, and various inflammatory disorders.

Theodore Roosevelt's Detached Retina

Roosevelt was an avid boxer in college and often invited sparring partners to box when he was governor of New York. After reaching the White House, Roosevelt continued this hobby. However, in 1908 an opponent landed a punch to the president's left eye, ending his boxing hobby. The blow caused a detached retina and eventually blindness in the eye. He was 50 years old at the time.

Roosevelt later wrote in his autobiography:

"I had to abandon boxing as well as wrestling, for in one bout a young captain of artillery cross-countered me on the eye, and the blow smashed the little blood vessels. Fortunately it was my left eye, but the sight has been dim ever since, and if it had been the right eye I should have been entirely unable to shoot.

"Accordingly I thought it better to acknowledge that I had become an elderly man and would have to stop boxing. I then took up jiujitsu for a few years."

References:

1. Chu, HC, Chan MY, Chau CYJ, et al. The use of ocular ultrasound for the diagnosis of retinal detachment in a local accident and emergency department. Hong Kong Journal of Emergency Medicine 2017, Vol. 24(6) 263–267

2. Shinar Z, Chan L, Orlinsky M. Use of ocular ultrasound for the evaluation of retinal detachment. J Emerg Med. 2011 Jan;40(1):53-7.

3. Bedside Ocular Ultrasound for the Detection of Retinal Detachment in the Emergency Department. Academic Emergency Medicine. 2010 Vol. 17(9), 913–917

4. Chicago Tribune. Teddy Roosevelt's little-known secret. http://articles.chicagotribune.com/2002-10-07/features/0210070158_1_boxing-final-bout-theodore-roosevelt-association

Kevin Rice, MD is the President of Global Radiology CME and serves as the Chair of Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator.

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