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BOOK TITLE: Retina: Medical and Surgical Management
Blunt trauma can cause ocular injury by three mechanisms—coup, contrecoup, or equatorial expansion. Coup injury occurs due to direct impact, for example, subconjunctival, choroidal or vitreous hemorrhage. Contrecoup injury is caused due to transmitted shock waves as in commotio retinae. Equatorial expansion occurs when blunt trauma causes compression along the anteroposterior axis, causing ocular damage. Vitreous hemorrhage results from trauma to the retina, choroid, or ciliary body. It may be associated with a retinal tear and hence a detailed fundus evaluation with scleral indentation should be performed when media permits. Choroidal rupture is a break in vascular choroid, Bruch’s membrane, and RPE, due to anteroposterior compression and equatorial expansion of the globe due to blunt ocular trauma.