Predisposing conditions:
(1) gazing at the sun
(2) direct viewing a solar eclipse ("eclipse burn", "eclipse blindness", "eclipse retinopathy")
(3) exposure to highly reflected sunlight (for example, glare from ice on a mountain)
The sunlight exposure may not always be reported, especially in small children or a person who has been substance abusing.
Clinical findings:
(1) central scotoma
(2) afterimage
(3) visual distortions (metamorphopsia)
(4) decreased visual acuity
(5) browache
Fundoscopic examination:
(1) Early there is a yellowish-gray lesion in the center of the fovea.
(2) Over several days this area takes on a permanent red appearance and becomes depressed.
(3) Macular pigmentary disruption may occur.
Fluorescein angiography initially shows leakage of dye at the foveal lesion. In severe cases a window defect may develop in the macula.
While many patients will regain normal visual acuity within 6 months, some patients may have long-term or permanent residua.
