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Bilateral Ocular Injury From Lightning Strike

Harris, Kathleen BS*; Morris, Robert E. MD†,‡; Patel, Hershel R. MD†,‡; Oltmanns, Matthew H. MD†,‡

Section Editor(s): Toth, Cynthia A.; Cai, Cindy X.; Cai, Sophie

doi: 10.1097/IAE.0000000000002692
Photo Essay

*School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama;

Retina Specialists of Alabama, Birmingham, Alabama; and

The Helen Keller Foundation for Research and Education, Birmingham, Alabama.

Reprint requests: Robert E. Morris, MD, Retina Specialists of Alabama, LLC, 2208 University Boulevard, Suite 101, Birmingham, AL 35233; e-mail:

The authors have no conflicts of interest, financial, or otherwise, to disclose. This research is deemed exempt from IRB review by the University of Alabama at Birmingham Institutional Review Board.

RETINA® is now accepting manuscripts for consideration for publication in the Photo Essay section. For a manuscript to be considered for publication within this section, the significance of the manuscript should revolve around the photographs. The photographs should convey an important or unique clinical diagnosis, condition, or treatment. The photographs can be a combination of kodachromes, angiograms, histologic sections, or ancillary diagnostic studies (e.g., echograms, radiograms, CT or MRI studies, arteriograms), all of which are imperative in the evaluation, diagnosis, and/or treatment of the condition that is represented. Overall, the Photo Essay manuscript will be limited to 300 words, five photographs, and five references. All figures submitted in color will be published in color at the expense of the authors. Please refer to the Author Instructions for all other general requirements of manuscripts submitted to RETINA®.

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Although lightning strike injury is rare, more than half of victims suffer some form of ophthalmic injury.1 We present photo documentation of the most severe case of bilateral lightning strike eye injury thus far reported.

A 58-year-old man presented four decades after a lightning strike injury to both eyes at age 18.

The left eye ultimately lost all light perception. The right eye regained 20/25 visual acuity after cataract extraction and limited peripheral vision sufficient for him to be a licensed driver for decades. During the past year, however, the patient reported a gradual decrease in visual acuity in the right eye.

Examination showed bilateral aphakia, marked optic disc pallor in both eyes, and severe bilateral choroidal atrophy of the posterior pole. The right eye had a peripapillary choroidal scar, barely extending subfoveal, with visual acuity of 20/80 and an atrophic central fovea measuring 148 μm in thickness by optical coherence tomography (Figure 1A). In the (NLP) left eye, the choroidal scar extended diagonally from the inferonasal periphery through the macula into the superotemporal periphery (Figure 1B).

Fig. 1

Fig. 1

Previous studies show optical coherence tomography and/or fundus images of lightning injury to the posterior segment, but this is the first reported case of ultra-widefield imaging of such extensive choroidal damage.2,3 These lesions apparently result from thermal injury when heavy melanin content in the central fundus resists tissue electrical currents set up by lightning strikes.

Images taken within months after the injury showed similar, heavily pigmented lesions. Late deterioration of right eye foveal function is explainable by the phenomena of subfoveal “pigment creep.”4 The “flashover” effect of lightning transmission along the body's surface is often protective of deeper organs, but a tendency for orbital current penetration and ischemic damage to neural tissue accounts for the high percentage of ocular injury.5

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The authors thank Christina Sullivan for her assistance with this article and C. Diane Scharper for final editing.

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1. Edelstein J, Peters W, Cartotto R. Lightning injury: a review and case presentations. Can J Plast Surg 1994;2:164–168.
2. Armstrong B, Fecarotta C, Ho AC, Baskin DE. Evolution of severe lightning maculopathy visualized with spectral domain optical coherence tomography. Ophthalmic Surg Lasers Imaging 2010;41:S71–S73.
3. Liu TYA, See C, Singman E, Han IC. Delayed onset of intraretinal cystoid abnormalities in lighting retinopathy. JAMA Ophthalmol 2016;134:840–842.
4. Morgan CM, Schatz H. Atrophic creep of the retinal pigment epithelium after focal macular photocoagulation. Ophthalmol 1989;96:96–103.
5. Norman ME, Albertson D, Younge BR. Ophthalmic manifestations of lightning strike. Surv Ophthalmol 2001;46:19–24.

lightning strike; eye injury; ocular trauma; choroidal atrophy

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