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Abstract
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Gay and Abbott introduced the term "whiplash injury" in 1953 to describe the mechanism of acute cervical trauma, originating usually after a rear-end automobile collision, which produced no obvious direct head injury nor loss of consciousness. The condition has been frequently described and thoroughly documented from the anatomical, surgical and medico-legal aspects, many orthopedic surgeons preferring to call the entity "acute traumatic cervical syndrome".
Interestingly enough, most histories given are strikingly similar as far as symptoms go, whether the agent is a traumatic acceleration-deceleration experience or a crick in the neck due to a fall. Following the accident, patients complain of headache, pain and discomfort in the neck, nausea, dizziness, tinnitus and inability to concentrate. Physical exam reveals no gross abnormalities; but ocular symptoms may be prominent within a few hours: extreme fatigue, blurred vision, diplopia, photophobia and reading difficulties. Anxiety and varying degree of depression soon follow. It has been customary to attribute many of these symptoms of cervical trauma to psychoneurosis and to dismiss the patient's complaints as evidence of "psychic inadequacies". This attitude has been especially evident in cases in which ocular changes followed whiplash. In our experience, a malingerer may occasionally be encountered, but as a rule, we deal with the hyper-responsive, tense and emotional individual, not hard to identify by means of a detailed history, asking the proper questions and above all, by thorough examination.
I report a case series of 16 patients. Their ocular manifestations of whiplash injuries were amaurotic episodes, decreased accommodation and convergence, decreased prism vergence power, anisocoria, diplopia, light sensitivity, extraocular muscle imbalances, ptosis, possible vitreous detachment, tearing. Management and prognosis are considered as well as the role of pathogenetic factors in the production of the syndrome. |