Failure to Order Medical Imaging Leads to Permanent Vision Loss

Description

A young adult suffers retinal detachment and vision loss due to a delayed diagnosis and treatment of a retained foreign body (RFB) in one eye.

Clinical Sequence

A healthy, young professional presented to an ophthalmologist one day after a piece of metal hit them in the eye. They were diagnosed with a scleral laceration and referred to a second ophthalmologist. The patient was seen two days after the injury and the second ophthalmologist noted visible vitreous at the site and repaired the scleral laceration. On the fourth day, the first ophthalmologist saw the patient again and documented their vision as 20/40 with some blurring.   

Two and four weeks later, the first ophthalmologist saw the patient and noted vision in the injured eye improved to 20/20. However, it was noted that the iris in the injured eye was not constricting appropriately, and they were referred back to the second ophthalmologist.

The patient visited the second ophthalmologist three weeks later, complaining of light flashes in the periphery of the injured eye and blurred vision. The physician documented a vitreous detachment; no intervention was required at that time. 

Two months later, the first ophthalmologist saw the patient again and diagnosed them with a cataract in the injured eye. The second ophthalmologist was also consulted due to decreased visual acuity with increased debris in the vitreous. The patient’s vision was documented as 20/70. An ultrasound was performed, and no foreign bodies were noted in the eye.

Approximately one week later, the second ophthalmologist performed surgery, followed by a vitrectomy two weeks later. During the procedure, the physician found and removed a metallic foreign body within the anterior vitreous at the root of the iris.

The patient had follow-up visits with each ophthalmologist, and vision in the injured eye continued deteriorating. The patient was diagnosed with retinal detachment and proliferative vitreoretinopathy, which required additional surgery.

Outcome

The patient had permanent loss of vision in the affected eye.  

Allegation

A claim was brought against the ophthalmologists, alleging a delay in diagnosing a retained metal fragment in the eye, which resulted in a delay in treatment and vision loss.

Disposition

The expert review of the case was critical of both ophthalmologists for failure to order a CT or X-ray to rule out a foreign body and that the delayed diagnosis of the foreign body likely caused the permanent vision loss. This case was settled for more than $1M.

Analysis

The failure to order a test resulted in a delay in diagnosis and treatment.