Risk of Retinal Tears in Patients with Autism Who Engage in Self-Inflicted Temple Punches

Mechanism of Injury and Risk Factors

The mechanical force from repeated temple punches can cause sudden acceleration-deceleration of the vitreous, creating traction at sites of vitreoretinal adhesion 1, 2
Trauma-induced posterior vitreous detachment (PVD) can occur earlier than the typical age-related PVD (which normally occurs between ages 45-65) 3

Vitreous hemorrhage and/or localized intraretinal hemorrhage may accompany traumatic PVD events 2, 4
The presence of vitreous pigmented cells is a critical warning sign that indicates possible retinal damage 5
Traumatic retinal dialysis (a specific type of crescentic peripheral retinal break at the ora serrata) is commonly associated with blunt trauma 2
Symptoms that warrant immediate evaluation include new onset or increased floaters 3, flashes of light (photopsia) 3, visual field defects 1, and decreased visual acuity 1

Symptomatic retinal breaks with persistent vitreoretinal traction (horseshoe or flap tears) have at least a 50% risk of progressing to clinical retinal detachment if left untreated 6
Treatment by prompt creation of a chorioretinal adhesion around symptomatic tears reduces the risk of retinal detachment to less than 5% 6
Traumatic dialyses and tears along the vitreous base should be managed similarly to symptomatic tears 6

Regular ophthalmologic screening is crucial for early detection of retinal pathology in patients with autism who engage in self-injurious behavior 5

Regular ophthalmologic follow-up is necessary to monitor for new retinal breaks or detachment 5
Both eyes should be evaluated, as pathologic vitreoretinal changes can occur bilaterally even if trauma appears unilateral 5