This patient presented with subretinal fibrosis associated with a shallow retinal detachment and several granulomatous retinal lesions. This presentation is consistent with a longstanding inflammatory process with the granulomatous lesions as the focus of the inflammation. One of the most common causes for granulomatous retinal lesion is a Toxocara or Toxoplasma infection. The patient probably did not have cause to compare eyes prior to being hit in the eye and therefore reported acute loss of vision. Whenever fusional ability is lost due to reduced vision, strabismus can develop. Additional tests that were ordered were a Toxocara and Toxoplasma titer. The Toxoplasma titer came back negative, and unfortunately, the Toxocara titer was not done by the laboratory due to an undefined problem with the blood sample. In either case, a positive test is not diagnostic, since about 7% and 25% of the general population are seropositive for Toxocara and Toxoplasma respectively. However, a negative result for both tests should alert the clinician to other possible causes of the inflammation.

Other reported etiologies of subretinal fibrosis include chronic retinal detachment, uveitis, choroidal neovascularization, multifocal choroiditis, diabetic macular edema, radiation treatment to the retina and bilateral juxtafoveal telangiectasis. There is no practical treatment for old Toxoplasma or Toxocara lesions with subretinal fibrosis and therefore observation of the patient, prescription of safety lenses and education on loss of depth perception and possible career implications is all that may be required. However, when active inflammation is found with a shallow retinal detachment, a pars plana vitrectomy and a scleral buckle procedure may benefit the patient and appropriate referral is indicated.