![]() (a) Direct strike that occurs when the victim is struck directly by the lightning discharge. There are five types of lightning strike. In the present article, PubMed search of articles related to posterior segment injuries caused by lightning using keywords (lightning injury, ophthalmic manifestations, ocular injuries, posterior segment, and retinopathy) was conducted and 19 case reports in 17 articles including 29 eyes with lightning injury to the posterior segment of the eye from 1984 to 2019 were reviewed. ![]() It has been earlier reported that the most common affected ocular structures after lightning injury are generally the cornea, where epithelial erosions being the most common injury, and the lens, where the percentage of formation of anterior and posterior subcapsular cataracts can reach 6%–7% however, in the past decade, with the advent of optical coherence tomography (OCT), more number of posterior segment pathologies due to lightning injury were picked up. Intraocular injury secondary to lightning strike has been appreciated since 1772 when Saint Yves reported the first lightning-induced cataract. Ophthalmic injuries due to lightning occur mainly from direct or indirect transmission of electric charge, resistance-induced heat, or heat-induced shock wave. More than half of all lightning victims suffer from some form of lightning injury. The contact temperature may rise up to approximately 8000☌–300,000☌. The magnitude of discharge in lightning has been estimated at many millions to 1 billion Volts, the current at 12,000–200,000 Amps, and the current's duration at 1/1000 th to 1/100 th of a second. Worldwide, there are approximately 50,000 thunderstorms every day, which produce about 8 million lightning strikes daily. We conclude that although lightning injuries are usually mild injuries, with vision remaining, either stable or showing some improvement in the majority of cases, severe visual loss due to optic atrophy and maculopathy may occur in long term. A variety of other retinal, vitreous, and electrophysiological abnormalities have also been reported. The macula was the most common site of involvement with retinal pigment epithelial changes ( n = 14, 48%) being the most common manifestation. ![]() Most patients ( n = 10, 53%) had bilateral injury. Eleven patients (58%) were in the age group of 10–30 years. The majority of case reports ( n = 10, 53%) were from North America. PubMed search of articles related to posterior segment injuries caused by lightning using keywords (lightning injury, ophthalmic manifestations, ocular injuries, and posterior segment) was conducted, and 19 case reports in 17 articles including 29 eyes with lightning injury to the posterior segment of the eye from 1984 to 2019 were reviewed. Ophthalmic injuries due to lightning are due to direct or indirect transmission of electric current, resistance-induced heat, and heat-induced shock wave. Lightning causes serious injuries and deaths worldwide every year.
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