Can self-inflicted temple punches cause retinal detachment?

Traumatic Retinal Detachment from Self-Inflicted Temple Punches

Self-inflicted punches to the temple are unlikely to cause retinal detachment in most cases, but repeated severe trauma could potentially lead to retinal breaks and subsequent detachment in rare circumstances.

Mechanism of Traumatic Retinal Detachment

• Retinal detachment occurs when the retina is pulled away from its normal position, with traumatic retinal detachments accounting for 10-20% of all detachments 1
• Blunt trauma can cause retinal detachment through two primary mechanisms:
  • Shockwave propagation in the retina leading to retinal breaks, particularly in the ora serrata region 1
  • Negative pressure during eye decompression after impact, which can pull the retina away from supporting tissue 1

Traumatic Retinal Breaks and Detachment

• Traumatic retinal breaks, including retinal dialysis (a specific type of crescentic peripheral retinal break at the ora serrata), are typically associated with significant trauma 2
• Traumatic breaks and dialyses along the vitreous base are managed similarly to symptomatic tears due to their high risk of progression to detachment 2
• The force required to cause retinal breaks through blunt trauma is substantial - research shows that high-velocity impacts (e.g., 50 m/s) are typically needed to exceed the threshold for retinal break 1

Self-Inflicted Trauma and Retinal Detachment

• Most documented cases of self-inflicted retinal detachment involve patients with intellectual disabilities and severe, chronic self-injurious behaviors 3, 4, 5
• In a multicenter study of self-injurious behavior causing retinal detachment, face hitting was the most common mechanism (74.4%), but these were typically in patients with conditions like autism spectrum disorder (35.9%) or trisomy 21 (21.8%) 3
• These patients often exhibit severe, repetitive self-injury over extended periods, which differs from isolated episodes of self-punching 3, 4

Risk Assessment for Temple Punches

• The temple region is not directly over the eye, which provides some protection compared to direct ocular trauma
• For retinal detachment to occur from temple punches:
  • The force would need to be sufficient to transmit shockwaves to the retina 1
  • Repeated trauma would likely be necessary to create cumulative damage 3
  • The punches would need to be of significant force to cause the eye deformation necessary for retinal break formation 1

Clinical Implications

• Symptoms that would warrant immediate evaluation after head/face trauma include:
  • New onset of flashes and floaters (photopsias) 6
  • Sudden vision loss or visual field defects 2
  • Vitreous hemorrhage, which can be a presenting sign of retinal tears 2
• Between 8% and 22% of patients with acute posterior vitreous detachment (which can be triggered by trauma) have a retinal tear at initial examination 2

Conclusion

While self-inflicted punches to the temple could theoretically cause retinal detachment, this would be a rare occurrence requiring either extremely forceful impact or repeated trauma over time. The documented cases of self-inflicted retinal detachment typically involve severe, chronic self-injurious behavior in patients with intellectual disabilities rather than isolated episodes of self-punching.