Photic retinopathy

Last updated
Photic retinopathy
Other namesFoveomacular 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]

Contents

Signs and symptoms

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.

See also

Related Research Articles

<span class="mw-page-title-main">Retinopathy</span> Medical condition

Retinopathy is any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to retinal vascular disease, or damage to the retina caused by abnormal blood flow. Age-related macular degeneration is technically included under the umbrella term retinopathy but is often discussed as a separate entity. Retinopathy, or retinal vascular disease, can be broadly categorized into proliferative and non-proliferative types. Frequently, retinopathy is an ocular manifestation of systemic disease as seen in diabetes or hypertension. Diabetes is the most common cause of retinopathy in the U.S. as of 2008. Diabetic retinopathy is the leading cause of blindness in working-aged people. It accounts for about 5% of blindness worldwide and is designated a priority eye disease by the World Health Organization.

<span class="mw-page-title-main">Diabetic retinopathy</span> Medical condition

Diabetic retinopathy (DRP, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes mellitus. It is a leading cause of blindness in developed countries.

<span class="mw-page-title-main">Hypertensive retinopathy</span> Medical condition

Hypertensive retinopathy is damage to the retina and retinal circulation due to high blood pressure.

<span class="mw-page-title-main">Macula of retina</span> Oval-shaped pigmented area near the center of the retina

The macula (/ˈmakjʊlə/) or macula lutea is an oval-shaped pigmented area in the center of the retina of the human eye and in other animals. The macula in humans has a diameter of around 5.5 mm (0.22 in) and is subdivided into the umbo, foveola, foveal avascular zone, fovea, parafovea, and perifovea areas.

<span class="mw-page-title-main">Vitrectomy</span> Type of eye surgery

Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye.

<span class="mw-page-title-main">Retinoschisis</span> Eye disease involving splitting of the retina

Retinoschisis is an eye disease characterized by the abnormal splitting of the retina's neurosensory layers, usually in the outer plexiform layer. Retinoschisis can be divided into degenerative forms which are very common and almost exclusively involve the peripheral retina and hereditary forms which are rare and involve the central retina and sometimes the peripheral retina. The degenerative forms are asymptomatic and involve the peripheral retina only and do not affect the visual acuity. Some rarer forms result in a loss of vision in the corresponding visual field.

<span class="mw-page-title-main">Macular edema</span> Medical condition

Macular edema occurs when fluid and protein deposits collect on or under the macula of the eye and causes it to thicken and swell (edema). The swelling may distort a person's central vision, because the macula holds tightly packed cones that provide sharp, clear, central vision to enable a person to see detail, form, and color that is directly in the centre of the field of view.

<span class="mw-page-title-main">Scanning laser ophthalmoscopy</span>

Scanning laser ophthalmoscopy (SLO) is a method of examination of the eye. It uses the technique of confocal laser scanning microscopy for diagnostic imaging of the retina or cornea of the human eye.

<span class="mw-page-title-main">Fovea centralis</span> Small pit in the retina of the eye responsible for all central vision

The fovea centralis is a small, central pit composed of closely packed cones in the eye. It is located in the center of the macula lutea of the retina.

This is a partial list of human eye diseases and disorders.

<span class="mw-page-title-main">Macular degeneration</span> Medical condition associated with vision loss

Macular degeneration, also known as age-related macular degeneration, is a medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Visual hallucinations may also occur but these do not represent a mental illness.

Flash blindness is an either temporary or permanent visual impairment during and following exposure of a varying length of time to a light flash of extremely high intensity, such as a nuclear explosion, flash photograph, lightning strike, or extremely bright light, i.e. a searchlight, laser pointer, landing lights or ultraviolet light. The bright light overwhelms the retinas of the eyes and generally gradually fades, lasting anywhere from a few seconds to a few minutes. However, if the eyes are exposed to a high enough level of light, such as a nuclear explosion, the blindness can become permanent.

<span class="mw-page-title-main">Epiretinal membrane</span> Eye disease

Epiretinal membrane or macular pucker is a disease of the eye in response to changes in the vitreous humor or more rarely, diabetes. Sometimes, as a result of immune system response to protect the retina, cells converge in the macular area as the vitreous ages and pulls away in posterior vitreous detachment (PVD). PVD can create minor damage to the retina, stimulating exudate, inflammation, and leucocyte response. These cells can form a transparent layer gradually and, like all scar tissue, tighten to create tension on the retina which may bulge and pucker, or even cause swelling or macular edema. Often this results in distortions of vision that are clearly visible as bowing and blurring when looking at lines on chart paper within the macular area, or central 1.0 degree of visual arc. Usually it occurs in one eye first, and may cause binocular diplopia or double vision if the image from one eye is too different from the image of the other eye. The distortions can make objects look different in size, especially in the central portion of the visual field, creating a localized or field dependent aniseikonia that cannot be fully corrected optically with glasses. Partial correction often improves the binocular vision considerably though. In the young, these cells occasionally pull free and disintegrate on their own; but in the majority of those affected the condition is permanent. The underlying photoreceptor cells, rod cells and cone cells, are usually not damaged unless the membrane becomes quite thick and hard; so usually there is no macular degeneration.

<span class="mw-page-title-main">Macular hypoplasia</span> Medical condition

Macular hypoplasia is a rare medical condition involving the underdevelopment of the macula, a small area on the retina responsible for seeing in detail and sensing light. Macular hypoplasia is often associated with albinism.

<span class="mw-page-title-main">Vision disorder</span> Medical condition

A vision disorder is an impairment of the sense of vision.

<span class="mw-page-title-main">Macular telangiectasia</span> Disease of the retina affecting central vision

Macular telangiectasia is a condition of the retina, the light-sensing tissue at the back of the eye that causes gradual deterioration of central vision, interfering with tasks such as reading and driving.

Berlin's edema a common condition caused by blunt injury to the eye. It is characterized by decreased vision in the injured eye a few hours after the injury. Under examination the retina appears opaque and white in colour in the periphery but the blood vessels are normally seen along with "cherry red spot" in the foveal region. This whitening is indicative of cell damage, which occurs in the retinal pigment epithelium and outer segment layer of photoreceptors. Damage to the outer segment often results in photoreceptor death through uncertain mechanisms. Usually there is no leakage of fluid and therefore it is not considered a true edema. The choroidal fluorescence in fluorescent angiography is absent. Visual acuity ranges from 20/20 to 20/400.

<span class="mw-page-title-main">Vitreomacular adhesion</span> Human medical condition

Vitreomacular adhesion (VMA) is a human medical condition where the vitreous gel of the human eye adheres to the retina in an abnormally strong manner. As the eye ages, it is common for the vitreous to separate from the retina. But if this separation is not complete, i.e. there is still an adhesion, this can create pulling forces on the retina that may result in subsequent loss or distortion of vision. The adhesion in of itself is not dangerous, but the resulting pathological vitreomacular traction (VMT) can cause severe ocular damage.

Microperimetry, sometimes called fundus-controlled perimetry, is a type of visual field test which uses one of several technologies to create a "retinal sensitivity map" of the quantity of light perceived in specific parts of the retina in people who have lost the ability to fixate on an object or light source. The main difference with traditional perimetry instruments is that, microperimetry includes a system to image the retina and an eye tracker to compensate eye movements during visual field testing.

Geographic atrophy (GA), also known as atrophic age-related macular degeneration (AMD) or advanced dry AMD, is an advanced form of age-related macular degeneration that can result in the progressive and irreversible loss of retinal tissue which can lead to a loss of visual function over time. It is estimated that GA affects >5 million people worldwide and approximately 1 million patients in the US, which is similar to the prevalence of neovascular (wet) AMD, the other advanced form of the disease.

References

  1. 1 2 Mainster, Martin A; Turner, Patricia L. (2006). "Retinal Injuries from Light: Mechanisms, Hazards, and Prevention". Retina (4 ed.). Elsevier Mosby. pp. 1857-70.
  2. 1 2 3 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
  3. 1 2 3 Kallmark FP, Ygge J. "Photo-induced foveal injury after viewing a solar eclipse." Acta Ophthalmol Scand. 2005 Oct;83(5):586-9. PMID   16187997
  4. 1 2 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
  5. Dobson R. "UK hospitals assess eye damage after solar eclipse." BMJ. 1999 Aug 21;319(7208):469. PMID   10454393.
  6. 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.
  7. 1 2 3 Solar Retinopathy: Etiology, Diagnosis, and Treatment
  8. Solar Retinopathy — American Academy of Ophthalmology

7. ^ Stokkermans TJ, Dunbar MT. "Solar retinopathy in a hospital-based primary care clinic." J Am Optom Assoc. 1998 Oct;69(10):625-36. PMID   9805443