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Paper text:
a 20 year old boy presented to our department with decreased vision , redness and watering of both eyes following electrocution with overhead transmission wires six days ago .
he had multiple eschars on the back , scalp and arms along with facial erythema [ fig
his best - corrected visual acuity was light perception in the right eye and counting fingers in the left eye with normal intraocular pressures .
anterior segment examination showed bilateral circumcorneal congestion , sluggish pupillary reactions , superficial punctate keratitis and cataract in the left eye .
fundoscopy revealed an area of peripapillary retinal opacification and a dull foveal reflex in both eyes [ figs . 2 and 3 ] .
fundus fluorescein angiogram showed a normal retinal circulation with late hyperfluorescence corresponding to the area of opacification .
optical coherence tomography ( oct ) showed retinal thickening with few cystoid spaces in the right eye [ fig .
similar changes were seen the left eye ( not shown ) . patient was started on oral corticosteroids ( prednisolone 30 mg / day ) and acetazolamide ( 750 mg / day in three divided doses ) .
steroids were given to control inflammation arising from the injury , if any , and oral carbonic anhydrase inhibitor were added to reduce cystic fluid collection by possible stimulation of the retinal pigment epithelium ( rpe ) pump .
acetazolamide was withdrawn after 1 month and oral steroids were discontinued after another month by gradual tapering .
one month later , his best corrected visual acuity was counting fingers 1 meter in the both eyes with posterior subcapsular cataract and peripapillary retinal atrophy in both the eyes [ fig . 5 ] .
oct of both the eyes showed retinal atrophy with disorganization of all retinal layers and the rpe [ fig .
patient underwent cataract surgery after 6 months from the time of injury in both the eyes with no improvement in the visual acuity .
photograph of the face of the patient in the study following electrical burn showing eschars , erythema and facial erythem fundus photograph of the right eye of the patient in the study at presentation showing areas of peripapillary retinal opacification with a dull foveal reflex fundus photograph of the left eye of the patient in the study at presentation showing areas of peripapillary retinal opacification with a dull foveal reflex optical coherence tomography of right eye of the patient in the study at presentation showing presence of retinal thickening and few cystic spaces .
the retinal thickening is predominantly nasal with disruption of the inner segment /outer segment ( is / os ) junction and retinal pigment epithelium ( rpe ) .
localized areas of posterior vitreous detachment can be observed fundus photograph of both eyesof the patient in the study taken at 1 month following injury showing almost complete resolution of retinal opacification with appearance of retinal atrophy in both eyes .
the area of retinochoroidal atrophy can be seen as patches of pigmented and depigmented retina .
right eye shows pallor of the optic disc and attenuation of inferior peripapillary retinal vessels is noted optical coherence tomography of right eye of the patient in the study at one month following injury showing retinal atrophy with disorganization of retinal layers and clumps of photoreceptor cells ( left eye not shown )
optic nerve is very good conductor of electricity , with the nerve tissue conducting electricity as any metal rod .
the retina usually suffers thethermal effects of injuries in the form of immediate coagulation of proteins and cells ,  and thus the initial whitening / opacification of the retina can be explained . the absorption of energy by the rpe results in retinal damage which was evident in the peripapillary and macular area in our patient .
a normal fluorescein angiogram indicates that the retinal opacification was not as a result of ischemia , but was due to the thermal coagulation of the retinal tissue . according to a recently published report , peripapillary
meridional changes in the eye have been noted in a patient suffering from electric injury .
our case illustrates that initial acute response following electric shock injury is the retinal opacification with increased retinal thickness , that subsequently progresses to retinal atrophy .
in this study , we have presented the case report of a 20 year old boy who suffered an electric injury shock , following which he showed peripapillary retinal opacification and increased retinal thickening that subsequently progressed to retinal atrophy . 
 the fluorescein angiogram revealed normal retinal circulation , thus indicating thermal damage to retina without any compromise to retinal circulation .