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Case of the Month I November 2019

Case of the Month
November 20, 2019

The Case

The patient was a 24 year-old healthy man who complained of a small blind spot in the right eye for several months, ever since he stared at the sun. The visual acuity was 20/25 OD and 20/20 OS. On examination, there was a pinpoint RPE disturbance in the central fovea of the right eye, which is difficult to see on the fundus photograph. The OCT shows a small central disruption of the ellipsoid zone. What is the most likely diagnosis?

This patient had solar retinopathy. He did not have a history of factors that can result in solar retinopathy, including viewing an eclipse, LSD use, and schizophrenia. Patients typically present with a central scotoma, dyschromatopsia, metamorphopsia, and a headache. The visual acuity is often in the 20/40-20/70 range initially and improves to 20/20 to 20/40 over the next 3-6 months. An initial, small yellowish spot evolves into a deep reddish discoloration. The disruption of the ellipsoid zone seen on our patient’s OCT is typical. Other factors that predispose to solar retinopathy are youth (clear lens), pupil dilation, relative emmetropia, and conditions (such as elevation) that allow more ultraviolet B radiation exposure.

Case Photos

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This patient had solar retinopathy. He did not have a history of factors that can result in solar retinopathy, including viewing an eclipse, LSD use, and schizophrenia. Patients typically present with a central scotoma, dyschromatopsia, metamorphopsia, and a headache. The visual acuity is often in the 20/40-20/70 range initially and improves to 20/20 to 20/40 over the next 3-6 months. An initial, small yellowish spot evolves into a deep reddish discoloration. The disruption of the ellipsoid zone seen on our patient’s OCT is typical. Other factors that predispose to solar retinopathy are youth (clear lens), pupil dilation, relative emmetropia, and conditions (such as elevation) that allow more ultraviolet B radiation exposure.

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