Photic Maculopathy – July 2016

July 2016

Case Presentation

A 17 year-old was referred to Illinois Retina Associates for sudden decreased vision in his right eye.

He was otherwise healthy, with no known past medical history and not taking any medication. He presented with sudden appearance of a “blank spot in vision” in the right eye the day before.

Examination

His visual acuity was 20/70 uncorrected, 20/50 with pinhole in the right eye, and 20/20 in the left eye. Anterior segment examination was unremarkable. On posterior segment examination, a small round yellowish lesion was noted close to the foveal center in the right eye. The left eye’s funduscopy was normal.

Differential Diagnosis

  • Focal Choroiditis (including infectious, inflammatory causes)
  • Multifocal Choroiditis
  • Solar Retinopathy
  • Photic Maculopathy
  • Other Dystrophy (cone-rod, etc)

Diagnostic Testing

Fundus photography showed the macular lesion (Figure 1), while the left eye appeared normal. Spectral-domain OCT showed disruption of the outer retinal layers (Figure 2).

 

Figure1
Figure 1
Figure2
Figure 2

 

 

Diagnosis

Upon further questioning, the patient recalled being at a dance party with bright moving lights and lasers the night before the decrease in vision. The most probable diagnosis was photic maculopathy.

Follow-Up

Over the next 7 months, the patient’s visual acuity stabilized at 20/50 in the right eye. The appearance of the macular lesion changed slightly on fundus photography, diminishing in size and appearing more pigmented (Figure 3). OCT imaging showed some restoration of the damaged outer retinal layers (Figure 4).

 

Figure 3
Figure 3
Figure4
Figure 4

 

 

Discussion

Photic maculopathy occurs after exposure to strong direct lights, which produce an electrochemical reaction leading to retinal damage. Multiple cases have been reported from different exposure sources, including operating microscopes, laser beams, arc welding, lighting. Solar retinopathy has a similar pathogenesis, except it tends to be binocular and is due to sun gazing.

Typically, the patients present with decreased vision and a yellow foveal spot which fades somewhat over time and may lead to localized hyper or hypopigmentation. OCT imaging usually shows disruption of the outer retinal layers or the RPE, which may either progress to atrophy or improve over time.

There is no treatment at this time, and close observation for the development of any other complication is recommended.

References

de Almeida FPP et al. Photic Myopathy Following Exchange of Crystalens: Clinical and Spectral-domain OCT Features. Retinal Physician. 2009 Oct.

Kweon EY et al. Operating microscope light-induced phototoxic maculopathy after transscleral sutured posterior chamber intraocular lens implantation. Retina. 2009 Nov-Dec;29(10):1491-5.

Posteal EA et al. Long-term follow-up of iatrogenic phototoxicity. Arch Ophthalmol. 1998 Jun;116(6):753-7.

Roe RH et al. Complications of Vitreoretinal Surgery. Review of Ophthalmology. 2008 Jan.