A 42-year-old male patient came to the emergency department after suffering a contusion to his left eye.
The patient had previously undergone phacoemulsification of the crystalline lens, with intraocular lens implantation; he subsequently underwent vitrectomy for retinal detachment. His post-surgery visual acuity was 2/10. On ophthalmological examination, visual acuity in the right eye was 10/10 and light perception and projection in the left eye. Biomicroscopically, the left eye showed moderate hyphema, significant iris dialysis with pupillary involvement, Descemet's folds and extreme hypotonia of the eyeball (later confirmed by applanation tonometry, which showed ocular tension close to zero). Fundus examination revealed a massive haemovitreous hemovitreous that made it impossible to visualise the retina. After ruling out an anterior penetrating injury, a diagnosis of suspected posterior scleral rupture was made and confirmed by orbital computerised axial tomography (CAT).

Given the condition of the globe, the patient was admitted and observation was indicated due to the high risk of massive expulsive suprachoroidal haemorrhage if surgery was performed1 . Antibiotic and corticosteroid treatment was prescribed, with close monitoring of the affected eye and the adelfus, as there was a possibility of sympathetic ophthalmia developing. Two weeks later, visual acuity improved from perceiving and projecting light to bulges, with a recovery of the structure of the eyeball; this was confirmed with a new orbital CT scan, showing a sealed posterior leakage point, compatible with reconstitution. After a few months of monitoring, there was progressive reabsorption of the haemovitreous tissue, with a significant choroidal scar rupture, which did not lead to an improvement in visual acuity due to macular and optic nerve involvement. In this case, at first we thought it was a massive ocular burst due to the initial CT image, but later, we thought that what really happened was a massive hyperpressure that compressed the eyeball giving the tomographic image and later, when the rupture was sealed, its constitution was recovered; the fact that the eyeball was vitrectomised contributed to all of this.