COMMENTARY

Eclipse 2017: There Goes the Sun (and Here Comes the Solar Retinopathy)

Christina M. Sorenson, OD

Disclosures

August 17, 2017

Solar Retinopathy: What to Expect

As we learned from the work of Gass,[2] solar retinopathy is not a straightforward thermal burn but the result of photooxidation.

Solar retinopathy is not a straightforward thermal burn but the result of photooxidation.

Ultraviolet A (UVA) and the blue wavelengths of visible light enter the eye, absorb in the retina, and create free radial molecules. The free radicals start oxidation of the surrounding tissues that ultimately cause damage to the cells of the retinal pigment epithelium (RPE) and the photoreceptors.[3]

Patients will present with a central visual complaint, such as blurred vision, central scotoma, or metamorphopsia. Additionally, they may note some alteration of their color vision or sensitivity to light. Their visual acuity may be normal or as poor as counting fingers, but it is commonly in the range of 20/40 to 20/60.

The retinal appearance will change over the postexposure course.[4] An acute presentation may look completely normal or present with macular edema. The edema resolves, leaving disruption in the RPE, which has been described as a central yellow spot with surrounding granular pigmentation resolving ultimately to a well-defined red circular spot over the foveola.[5] It is this defined red spot that has come to be the pathognomonic clinical finding in solar retinopathy.

It is this defined red spot [over the foveola] that has come to be the pathognomonic clinical finding in solar retinopathy.

The prognosis will vary depending upon the exposure time and the extent of the damage to the RPE and photoreceptors. If the inner segments have been damaged, the prognosis is worse and the ultimate visual acuity is worse.

As with any ocular trauma, the initial visual acuity and the rate of recovery can be a guide to the outcome; that is, a better initial visual acuity with a faster recovery results in a better outcome.[6] Recovery is usually obtained within the year of exposure.[4] The patient may be left with suboptimal visual acuity and a small central scotoma or could have a full recovery with no sequelae.

Monitoring solar retinopathy should include visual acuity, dilated retinal examination and imaging inclusive of photos, and optical coherence tomography.

While there is no definitive treatment for solar retinopathy, we do know that the use of steroids is contraindicated due to the risk for macular edema development.[7]

The management of this disorder requires excellent patient education, supervision, and time.

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