Common Symptoms
Asymptomatic. Decreased vision may be experienced if macula is involved. Mild/transient to severe/permanent declines in visual acuity depending on the degree/location of photoreceptor damage; associated with blunt trauma/contrecoup injuries.
76.1.2 Exam Findings
Retinal whitening/opacification occurs rapidly following injury (▶ Fig. 76.1, ▶ Fig. 76.2). Commotio retinae is associated with disruption of the outer retina and RPE and can be associated with other traumatic sequelae (retinal hemorrhage, macular hole, choroidal rupture, etc.). Severe cases are associated with pigmentary changes and retinal atrophy, and cases confined to the posterior pole are known as Berlin’s edema.
Fig. 76.1 Commotio retinae of the inferior macula following blunt trauma. (a) Fundus photograph demonstrating resolving commotio retinae involving the inferior macula. Other notable findings include a resolving macular lamellar hole and temporal intraretinal/subretinal hemorrhages. (b) Optical coherence tomography (OCT) images showing ellipsoid zone disruption (arrowheads) corresponding to areas of commotio retinae at the time of fundus photo with associated subfoveal fluid and foveal thinning. (c) Two weeks later, OCT demonstrates notable improvement in the subfoveal fluid and foveal architecture. Outer retinal disruption/loss is still present.
Fig. 76.2 Commotio retinae following blunt trauma with a soccer ball. (a) Fundus photograph reveals superior macular circular area of retinal whitening consistent with commotio, approximately 6 days after the injury. (b) Optical coherence tomography confirms severity of retinal injury given presence of significant outer retinal disruption and ellipsoid zone loss (arrowheads).
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