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					                                     C L I N I C A L       A N D      E X P E R I M E N T A L
                                                                                 Ocular injury due to bungee jumping Curtis and Collin
                                   OPTOMETRY

                                                         CASE REPORT

               Ocular injury due to bungee jumping



Edward B Curtis * SDONZ                      Background: Bungee jumping is a well-established recreational activity in New Zealand
H Barry Collin † AM PhD (Melb) DSc           and Australia which may be associated with injuries to the eyes and other tissues.
(NSW) FRCPath (Lond)                         Case history: A patient with a retinal haemorrhage which resulted from bungee jump-
*
  Christchurch New Zealand                   ing is reported and the clinical characteristics described.
†
  Department of Optometry and Vision         Discussion: There have been several reports of injury due to bungee jumping. The
Sciences, The University of Melbourne        types of ocular injury are reviewed and the aetiological theories discussed.

Accepted for publication: 3 June 1999        (Clin Exp Optom 1999; 82: 5: 193–195)



Key words: acceleration effects, bungee jumping, retinal haemorrhage




Bungee jumping is a well-established
recreational activity in New Zealand and
Australia. However, it is associated with
significant physical and physiological
stress due to the gravitational forces
involved.
  This report documents the ocular
changes occurring in one patient follow-
ing bungee jumping.
  Mr GP, aged 31 years, presented com-
plaining of an awareness of loss of vision
following a bungee jump undertaken in
Queenstown, New Zealand, about four
weeks previously.
  On examination, visual acuities were
R 6/6 and L 6/5. All other findings were
essentially normal except for a large pre-
retinal haemorrhage superior nasal to the
optic disc of the right eye (Figure 1).
  Mr GP was referred to an ophthalmolo-
                                                              Figure 1. A large pre-retinal haemorrhage superior nasal to
gist for assessment and management of
                                                              the optic disc of the right eye
the lesion and to assess if there was any
other damage, which may have resulted
from the bungee jump.


                                      Clinical and Experimental Optometry 82.5 September–October 1999
                                                                   193
Ocular injury due to bungee jumping Curtis and Collin



   The ophthalmologist found the                sub-conjunctival haemorrhage occurring              and considering the forces involved, it is
patient’s visual acuities to be unchanged       in a jumper who entered the water at the            surprising that there have not been more
and confirmed the presence of the large         termination of the jump. He concluded               ocular injuries.2 The increase in intravas-
pre-retinal haemorrhage associated with         that despite all appearances, the sport             cular pressure,6 particularly venous,8 may
a small area of vitreous haemorrhage. The       seemed remarkably safe from an ocular               be caused by the reverse of direction of
remainder of the eye and in particular the      perspective.                                        acceleration and the accompanying
peripheral retina were normal.                     In contrast to this, more recently there         increase in negative G force.8
   One treatment option was laser photo-        have been several reports of ocular effects            In addition, the kinetic energy of the
coagulation to ‘break open the haemor-          associated with bungee jumping. Typically,          liver may push on the diaphragm to in-
rhage’ and drain the blood. However, as         in patients with ocular damage, the ini-            crease the thoracic pressure.2 A rapid rise
the blood was away from the macula and          tial visual symptom after bungee jumping            in venous pressure around the eye results.9
should resolve slowly, the ophthalmologist      is blurred vision. Visual acuities may be           There is spontaneous rupture of superfi-
carried out no treatment.                       reduced slightly to 6/9,2 or dramatically           cial capillaries resulting in haemorrhagic
   The ophthalmologist also offered the         to 6/60,6,7 6/1208 or even to ‘count fin-           detachment of the internal limiting mem-
suggestion that the haemorrhage was             gers’.9 One jumper was also reported to             brane in the foveal region.9
associated with the patient holding his         have pain and headache behind the eyes                 Simons and Krol12 claim that after the
breath at the time of the jump.                 and this was followed six days later by             free-fall the body decelerates with a con-
                                                horizontal diplopia and nystagmoid jerks            sequent increase in the hydrostatic pres-
                                                on versions.7                                       sure in the blood vessels of the eye reach-
DISCUSSION
                                                   Hanbury 1 reported one patient with a            ing its maximum at the lowest point in
Bungee jumping began on Pentecost               quadrantic distribution of sub-conjunctival         the jump. The gravitational force has been
Island in the New Hebrides as an ancient        chemosis and haemorrhages, which were               estimated at between 2.5 and 3.0 G and
manhood initiation ceremony. 1,2 More           symmetrical in the upper nasal areas.               could be as high as 7.0 to 8.0 G.7 It has
recently, it has become popular in New          Sub-conjunctival haemorrhage has been               been estimated that only 3.0 G may be suf-
Zealand as a tourist attraction for thrill      reported by several other authors.8,10              ficient to cause haemorrhages in the eye.12
seekers. Since bungee jumping began in             Intraocular bleeding has been described             Optometrists and other primary care
New Zealand, approximately 50,000 peo-          as small, single or multiple/retinal haem-          health practitioners should be aware of
ple have tried the sport.3                      orrhages,8,10 which may be foveal,7 para-           the possible external and internal ocular
   This activity has a potential for produc-    foveal in the form of dot and blot haem-            damage which may result from bungee
ing bodily injury but the most common           orrhages 10 or scattered throughout the             jumping and should especially look for
ocular hazard perceived by the public is        fundus.6,11 Haemorrhages may also be sub-           retinal abnormalities.
only a transient red eye.1 The adventurers      hyaloid,2 pre-retinal,6 sub-internal limiting
may be trading a few seconds of sheer           membrane9,11 or into the vitreous.2                 ACKNOWLEDGEMENT
exhilaration for a lifetime of visual impair-      In some patients, the haemorrhages are           The authors would like to thank Mr J
ment.4                                          accompanied by macular oedema,6 which               Borthwick, the ophthalmologist who saw
   In spite of the large number of partici-     has been demonstrated in the late phase             Mr GP, for supplying information regard-
pants, the number of injuries appears to        of fluorescein angiography8 and cotton              ing the patient and for his valuable assist-
be small. From the statistics of the New        wool patches.6                                      ance in the preparation of this manu-
Zealand Compensation Corporation, 5                These central lesions may result in cen-         script.
there were no fatalities in 1994 or 1995.       tral9 or parafoveal10 scotomata. When as-
However, there were nine new claims of          sessed, there were no pupillary anomalies2
                                                                                                    REFERENCES
injury due to bungee jumping in 1994,           and neurological, x-ray, blood and liver            1. Hanbury PH. Bungy jumping. Aust NZ J
seven in 1995 and eight in 1996. In con-        tests were normal.6,10,11                              Ophthalmol 1990; 18: 29.
trast to this, David and colleagues6 claim         The mechanism by which these ocular              2. Jain BK, Talbot EM. Bungee jumping and
that the lethal accidents were due to mis-      changes become manifest is uncertain.                  intraocular haemorrhage. Brit J Ophthalmol
calculations of the extent to which the         Several causes have been postulated.                   1994; 78: 236-237.
                                                                                                    3. Clemett RS. Bungy jumping. Aust NZ J
‘rope’ would stretch and one case in which      Innocenti and Bell7 claimed that breath-               Ophthalmol 1991; 119: 88.
a jumper forgot to attach the rope.             holding and tensing of the abdominal                4. David DB, Mears T, Quinlan MP. Reply. Brit
   There appears to be little information       muscles are the main cause of a sudden                 J Ophthalmol 1994; 78: 948.
on the occurrence of ocular injuries.           rise in intrathoracic pressure and intrave-         5. New Zealand Accident Rehabilitation and
Clemett3 reported results of a survey of 73     nous pressure, which is thought to cause               Compensation Insurance Corporation
                                                                                                       Report 1994 to 1998.
New Zealand ophthalmologists over a             the haemorrhaging.                                  6. David DB, Mears T, Quinlan MP. Ocular
two-year period prior to 1991. Only one            Alternatively, gravitational forces may be          complications associated with bungee jump-
ocular injury was notified and that was a       the most important aetiological factor10               ing. Brit J Ophthalmol 1994; 78: 234-235.


                                         Clinical and Experimental Optometry 82.5 September–October 1999
                                                                      194
                                                                                       Ocular injury due to bungee jumping Curtis and Collin



7. Innocenti E, Bell TAG. Ocular injury result-
    ing from bungee-cord jumping. Eye 1994; 8:
    710-711.
8. Rens E. Traumatic ocular haemorrhage re-
    lated to bungee jumping. Brit J Ophthalmol
    1994; 78: 948.
9. Habib NE, Malik TY. Visual loss from bungee
    jumping. The Lancet 1994; 343: 487.
10. Chan J. Ophthalmic complications after
    bungee jumping. Brit J Ophthalmol 1994; 78:
    239.
11. Filipe JA, Pinto AM, Rosas V, Castro-Correia
    J. Retinal complications after bungee jump-
    ing. Int Ophthalmol 1994-95; 18: 359-260.
12. Simons R, Krol J. Visual loss from bungee
    jumping. The Lancet 1994; 343: 853.

Author’s address:
Edward B Curtis
Curtis Eye Care Optometrists
58 Armagh Street
Christchurch 1
NEW ZEALAND




                                                              Erratum
                                         In the March–June 1999 (82: 2–3: 59–73) issue of Clinical
                                         and Experimental Optometry, in the paper ‘Diabetic retino-
                                         pathy: classification, description and optometric manage-
                                         ment’ by Dr David Cockburn, two figure captions were
                                         incorrect. The correct captions are:




    Figure 7. This eye has proliferative diabetic retinopathy with new         Figure 8. Red-free photograph showing new vessels on the disc
    vessels on the disc, new vessels elsewhere and a preretinal                (NVD) and a less obvious small patch of new vessels elsewhere
    haemorrhage superior to the optic disc. Preretinal haemorrhages            (NVE) temporal and slightly inferior to the fovea. The patient
    lie between the internal limiting membrane and the vitreous face.          should be referred for evaluation for laser treatment as a matter
    They are a reliable sign of the presence of new vessels.                   of urgency.



                                            Clinical and Experimental Optometry 82.5 September–October 1999
                                                                         195

				
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