Solar Retinopathy

dok_zlo — 15.07.2023

A previously healthy 43-year-old man from Western Australia presented to the ophthalmology clinic with a 3-week history of blurry vision. He reported no eye pain or scotomas but did report a years-long practice of watching sunsets without eye protection. Visual acuity was 20/30 in the right eye and 20/50 in the left eye. A funduscopic examination in both eyes was normal (Panel A, left eye), as was the rest of the evaluation, including slit-lamp examination. Optical coherence tomography (OCT) of the left macula revealed a discontinuity in the inner and outer foveal photoreceptor segments and retinal pigment epithelium interdigitation zone (Panel B, arrow). OCT of the right macula was normal. A diagnosis of solar retinopathy was made. Solar retinopathy is a type of retinal photochemical injury caused by ultraviolet radiation. Causes include solar eclipse viewing, arc welder or laser pointer exposure, or direct sun gazing, as in this case. Although visual recovery can occur over a period of months, metamorphopsia (shape misperception) or central scotoma may be permanent in some cases. The patient was advised to wear eye protection against ultraviolet radiation and to avoid direct sun gazing. Unfortunately, the patient was lost to follow-up. Joshua Taylor, M.D. Lions Eye Institute, Nedlands, WA, Australia David C. Sousa, M.D., Ph.D. University of Melbourne, Melbourne, VIC, Australia N Engl J Med 2023; 389:165 DOI: 10.1056/NEJMicm2215436

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