A 59-year-old male with history of trabeculectomy in both eyes (OU) for primary angle-closure (please specify if so) glaucoma 8 months ago came with the complaint of sudden decrease in vision in OU for past 3 days. Best-corrected visual acuity was 6/18 in right eye (OD) and 6/12 in left eye (OS). Intraocular pressure was within normal limits in OU. Anterior segment examination of OU revealed well-formed blebs with posterior chamber intraocular lens. Fundus examination of OU revealed yellowish lesions at the macula, more prominent in OS [Fig. 1a and b]. Optical coherence tomography of OU revealed foveal hyperreflective lesions [Fig. 1c, d].
What is your next step?
- Ask for history of cardiovascular diseases
- Ask for history of sun gazing, sunbathing, or direct viewing of solar eclipse
- Ask for history of new-onset flashes or floaters
- Ask for history of hyperlipidemia.
Patient had a history of performing ritualistic sun gazing 3 days ago, following which he developed blurring of vision. Optical coherence tomography angiography (OCTA) scans of OU showed focal areas of nonperfusion in the choriocapillary layer with normal superficial and deep capillary plexus consistent with the diagnosis [Fig. 2].
B) Ask for history of sun gazing, sunbathing, or direct viewing of solar eclipse.
Solar retinopathy occurs due to photochemical injury occurring in the macula following prolonged exposure to light, like sungazing, eclipse viewing, exposure to welding light, and following endoillumination in rare scenarios. It presents as blurry vision, metamorphopsia, central scotoma, or dyschromatopsia. Diagnosis is made based on the presence of specific history and multimodal imaging including optical coherence tomography (OCT), OCTA, and autofluorescence. The presence of drop-out areas in the choriocapillaries slab indicates the involvement of choriocapillaries in addition to the photoreceptors and retinal pigment epithelial cells. It usually recovers spontaneously in 3–6 months, but majority of patients have residual central scotoma or reduced vision.
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1. González Martín-Moro J, Hernández Verdejo JL, Zarallo Gallardo J. Photic maculopathy:A review of the literature (ii). Arch Soc Esp Oftalmol (Engl Ed) 2018;93:542–50.
2. Padidam S, Burke MT, Apple DB, Suchomel JR, Lin X. Optical coherence tomography angiography findings in two cases of solar retinopathy. Retin Cases Brief Rep 2021;15:767–71.