Photic retinopathy

Photic retinopathy
Photic retinopathy
Other names	Foveomacular retinitis ; Solar retinopathy
Specialty	Ophthalmology

Photic retinopathy is damage to the eye's retina, particularly the macula, from prolonged exposure to solar radiation or other bright light, e.g., lasers or arc welders. The term includes solar, laser, and welder's retinopathy and is synonymous with retinal phototoxicity.^[1] It usually occurs due to staring at the Sun, watching a solar eclipse, or viewing an ultraviolet, Illuminant D65, or other bright light.^[1]

Signs and symptoms

Long-term reduced eyesight^[2]^[3]
Central or paracentral scotoma^[2]^[3]

Vision loss due to solar retinopathy is typically reversible,^[4] lasting for as short as one month^[2] to over one year.^[3] The fundus changes are variable and usually bilateral, mild cases often show no alteration and moderate to severe cases show a foveal yellow spot on the first days after exposure. After a few days it is replaced by a reddish dot often surrounded by pigment.

Permanent holes and lesions are possible; prognosis worsens with dilated pupils or prolonged exposure.

Pathophysiology

Although it is frequently claimed that the retina is burned by looking at the Sun, retinal damage appears to occur primarily due to photochemical injury rather than thermal injury. The temperature rise from looking at the Sun with a 3-mm pupil only causes a 4 °C increase in temperature, insufficient to photocoagulate. The energy is still phototoxic: since light promotes oxidation, chemical reactions occur in the exposed tissues with unbonded oxygen molecules.^[1] It also appears that central serous retinopathy can be a result of a depression in a treated solar damaged eye.^[4]^[5]^[6]

The duration of exposure necessary to cause injury varies with the intensity of light, and also affects the possibility and length of recovery.

Diagnosis

A person with photic retinopathy may notice an impairment in their vision, for example a spot that does not go away after a reasonable recovery time, or blurring. They may also have eye pain or headaches. Vision impairment is usually in both eyes, but can be in just one. Impairment of a person with 20/20 vision usually ends up being about 20/40 or 20/60, but can be better or far worse.^[7]

A doctor examining an eye with retinopathy may be able to see no signs at all, or a slight macular edema, which is a sort of blister on or under the macula, an oval colored spot normally visible to an eye doctor on each person's retina.

But while even that edema goes away, within a few days the patient will generally develop a discoloration of the retina at the injured point, often yellow or white, turning red over the next few weeks.

Treatment

Photic retinopathy generally goes away on its own over time, but there is no specific treatment known to be reliable for speeding recovery. One path sometimes attempted, which has unclear results, is to treat the initial macular edema with corticosteroids.^[7]

Prognosis

Generally speaking, people diagnosed with photic retinopathy recover visual acuity completely within two months,^[7]^[8] though more severe cases may take longer, or not see complete recovery at all.

References

^ ^a ^b Mainster, Martin A; Turner, Patricia L. (2006). "Retinal Injuries from Light: Mechanisms, Hazards, and Prevention". Retina (4 ed.). Elsevier Mosby. pp. 1857-70.
^ ^a ^b ^c Sefic-Kasumovic S, Firdus H, Alimanovic E, Ljaljevic S, Sefic M. "[Eye injuries caused by an eclipse of the sun]." Med Arh. 2000;54(1):41-4. PMID 10872275
^ ^a ^b ^c Kallmark FP, Ygge J. "Photo-induced foveal injury after viewing a solar eclipse." Acta Ophthalmol Scand. 2005 Oct;83(5):586-9. PMID 16187997
^ ^a ^b Chen JC, Lee LR. "Solar retinopathy and associated optical coherence tomography findings." Archived 2006-09-27 at the Wayback Machine Clin Exp Optom. 2004 Nov;87(6):390-3. doi:10.1111/j.1444-0938.2004.tb03100.x PMID 15575813
^ Dobson R. "UK hospitals assess eye damage after solar eclipse." BMJ. 1999 Aug 21;319(7208):469. PMID 10454393.
^ Hunyor AB. "Solar retinopathy: its significance for the ageing eye and the younger pseudophakic patient." Aust N Z J Ophthalmol. 1987 Nov;15(4):371-5. PMID 3435680.
^ ^a ^b ^c Solar Retinopathy: Etiology, Diagnosis, and Treatment
^ Solar Retinopathy — American Academy of Ophthalmology