BASICS
DESCRIPTION
Phototoxicity of the retinal pigment epithelium (RPE) and photoreceptor layers in the fovea due to exposure to sunlight.
EPIDEMIOLOGY
Incidence
Uncommon, but clusters of cases appear around eclipses
RISK FACTORS
• Eclipse watching, sun gazing, sunbathing
• Emmetropia/low hypermetropia, aphakia
• Vocation (e.g., aviation, military [e.g., aircraft reconnaissance], astronomy)
• Photosensitizing medications (e.g., tetracyclines), mydriatics, hallucinogenic drugs (e.g., LSD)
GENERAL PREVENTION
Protective shading (e.g., hats, visors, filtering lenses/sunglasses)
PATHOPHYSIOLOGY
• Photochemical damage: resulting from the nonthermal effects of visible spectrum short wavelength (i.e., blue) light and ultraviolet radiation to the RPE and photoreceptor layers.
• Sun exposure is thought to cause thermal damage. Light absorption by the RPE results in a rise in temperature of the surrounding tissues. The exposure also causes formation of reactive oxygen species.
ETIOLOGY
See “Risk Factors” and “Pathophysiology.”
DIAGNOSIS
HISTORY
• Unprotected solar eclipse viewing, sun gazing (i.e., related to religious rituals, psychiatric illnesses, hallucinogenic drugs), sunbathing, vocational exposure (e.g., aviation, military service, astronomy)
• Decreased visual acuity, central/paracentral scotomata, dyschromatopsia, and metamorphopsia can occur following prolonged sun exposure.
• Typically bilateral
PHYSICAL EXAM
• Early:
– Yellow–white spot in the fovea
Can have surrounding granular gray pigmentation.
• Late:
– The acute findings resolve in several weeks. In the chronic stage, there is a variable appearance to the fovea (ranging from a normal appearance to a pigmentary disturbance or a pseudolamellar hole appearance).
– A red, sharply demarcated, cyst-like lesion may persist.
– Eyes with better initial visual acuities are more likely to have unremarkable funduscopic examinations at follow-up.
DIAGNOSTIC TESTS & INTERPRETATION
Imaging
• Fluorescein angiography:
– Variable; may be unremarkable; window defects seen later in disease course.
• Optical coherence tomography:
– Acute findings:
– Hyporeflectivity at the level of the RPE/photoreceptor layer
– Associated hyperreflectivity of the injured neurosensory retina has been described.
– Chronic/late findings:
Central defect (hyporeflectivity) at the level of the photoreceptor inner segment–outer segment junction
Foveal atrophy
Pathological Findings
• Concentrated in foveal and parafoveal regions
– Photoreceptors: swelling of outer segments, fragmentation of lamellae, mitochondrial swelling within the inner segments, nuclear pyknosis, and atrophy have been described.
– RPE: irregular pigmentation/depigmentation and atrophy can occur.
DIFFERENTIAL DIAGNOSIS
• Macular hole
• Idiopathic macular telangiectasia type 2
• Cone dystrophy
• Age-related macular degeneration
TREATMENT
None
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Monthly for the first few months, then as needed.
PATIENT EDUCATION
See “General Prevention.”
PROGNOSIS
• Eyes with better visual acuities on initial examination tend to recover more vision.
• Central/paracentral scotomata can persist, despite improvement in visual acuity.
• Long-term significant reduction in visual acuity is rare.
REFERENCES
1. Yannuzzi LA, Fisher YL, Krueger A, et al. Solar retinopathy: A photobiological and geophysical analysis. Trans Am Ophthalmol Soc 1987;85:120–158.
2. Hope-Ross MW, Mahon GJ, Gardiner TA, et al. Ultrastructural findings in solar retinopathy. Eye 1993;7:29–33.
3. Garg SJ, Martidis A, Nelson ML, et al. Optical coherence tomography of chronic solar retinopathy. Am J Ophthalmol 2004;137:351–354.
4. Wu J, Seregard S, Algvere PV. Photochemical damage of the retina. Surv Ophthalmol 2006;51:461–481.
5. Jain A, Desai RU, Charalel RA, et al. Solar retinopathy: Comparison of optical coherence tomography (OCT) and fluorescein angiography (FA). Retina 2009;29:1340–1345.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
