Clinical Features

The clinical features are as follows:

• Most patients present within a few days postinjury, although some people delay their visit to the ophthalmologist for months or even years.

• The most common initial symptoms are decreased visual acuity8, central scotoma9, and a negative afterimage of the sun, which may last several hours. The damage may be bilateral or unilateral (usually in the dominant eye).

• The typical ophthalmoscopic lesion is a small, yellow-grayish spot in or near the fovea, surrounded by macular edema. The edema resolves in days or weeks, after which the macula may look normal or show minor pigmentary disturbance. Foveolar depression or pseudohole may be observed, but a true macular hole is rare [9].

• The FLAG is usually normal, although a macular window defect is occasionally observed.

6 It can be much larger if focal damage to the nerve fiber layer has also occurred.

7 Retinal damage has been reported following direct observation of the sun through sunglasses, smoked glass, or exposed film, and even after exposures lasting only a few seconds.

8 Visual acuity worse than 20/80 is exceptional.

9 Can be identified even in the presence of 20/20 acuity.

• There is no known therapy for acute solar retinopathy. Corticosteroids are sometimes given, but their efficacy is unknown.

• Early visual improvement is the rule, occurring mostly within a few weeks or months. Final acuity is typically 20/25 or better, but a small central or paracentral scotoma may persist. The outcome is less favorable in atypical severe cases with low initial acuity. Late complications are rare.

O Pearl

The safest way to observe the sun or its eclipse is indirect: looking at the image of the sun projected onto a piece of paper through a pinhole aperture in a cardboard.

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