|Year : 2022 | Volume
| Issue : 2 | Page : 465-467
Acute eclipse retinopathy: Significance of hyper-reflective foci on optical coherence tomography scan - A case report
Iva R Kalita1, Harsh V Singh2
1 Paediatric Ophthalmology and Strabismus Services, Sitapur Eye Hospital, Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
2 Vitreo-retina and Uvea Services, Sitapur Eye Hospital, Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
|Date of Submission||24-Aug-2021|
|Date of Acceptance||31-Dec-2021|
|Date of Web Publication||13-Apr-2022|
Iva R Kalita
Paediatric Ophthalmology and Strabismus Services, Sitapur Eye Hospital, Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Eclipse retinopathy is a rare clinical entity occurring as a result of unprotected gazing at the solar eclipse. OCT features of eclipse retinopathy vary with time of presentation and degree of damage. The presence of hyperreflective foci (HRF) in acute solar retinopathy has never been described in past. We are reporting a case of eclipse retinopathy presenting very early with asymmetrical involvement of the right eye (RE) more than the left eye (LE). We demonstrated the presence of HRF on early OCT corresponding to the degree of damage and correlating with final visual recovery (LE complete recovery while RE incomplete visual recovery).
Keywords: Eclipse retinopathy, HRF, outer retinal microholes, solar retinopathy, vitreous hyperreflective foci
|How to cite this article:|
Kalita IR, Singh HV. Acute eclipse retinopathy: Significance of hyper-reflective foci on optical coherence tomography scan - A case report. Indian J Ophthalmol Case Rep 2022;2:465-7
|How to cite this URL:|
Kalita IR, Singh HV. Acute eclipse retinopathy: Significance of hyper-reflective foci on optical coherence tomography scan - A case report. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 24];2:465-7. Available from: https://www.ijoreports.in/text.asp?2022/2/2/465/342936
Eclipse retinopathy is a rare but well-known clinical entity, referred to as maculopathy, occurring as a result of prolonged or intense exposure to solar radiation causing direct thermal damage and indirect damage because of underlying photochemical reaction. Solar retinopathy carries a good visual prognosis with recovery within few days to months following exposure, but the rate of recovery and the final visual acuity depend on the duration of exposure and vision at presentation.
Structural OCT changes in eclipse retinopathy have been described in the past,[3–6] but many of these findings does show variable degree of retinal structural involvement due to varying timing of presentation and the reversible course of the disease.
Moreover, none of the studies mentioned the presence of vitreous and retinal hyperreflective foci (HRF) at presentation and its resolution with disease recovery.
Purpose of the study
To describe a case of acute solar retinopathy and show the significance of HRF on OCT in the case of acute eclipse retinopathy and their resolution with the recovery of visual acuity on serial follow-up.
| Case Report|| |
We report a 9-year-old female presenting with a complaint of bilateral central scotoma noted 4 h after the exposure to solar eclipse. She gave a history of staring at the eclipse for around 10 min. At presentation, her visual acuity was 6/18 and 6/12 in her right and left eye, respectively. Anterior segment evaluation was normal for both eyes. On fundus examination, a faintly visible well-circumscribed yellowish lesion was noted at the foveal center in both eyes which was more prominent on FAF as a circular ring of hypo-autofluorescence with fovea as the center, and the corresponding subfoveal grayish lesion was noted on multicolor images [Figure 1] and [Figure 2]. OCT scan taken on the same day showed increased subfoveal reflectivity of all retinal layers with the presence of HRF in inner layers and vitreo-retinal (VR) interface, more so in the left eye. She underwent routine workup to rule out other possible causes of inflammations. Follow-up OCT scan taken at 1st month and 3rd month showed progressive resolution of HRF and complete resolution of retinal hyperreflectivity with subfoveal outer retinal layer disruption (LE > RE) [Figure 3]. FAF on follow-up showed reduction in the size of hypo-autofluorescence ring to normal in both eyes, and corresponding multicolor imaging also showed complete resolution of the central subfoveal gray lesion in left eye with reduction in size of lesion in right eye [Figure 4]c.
|Figure 1: Fundus photograph at presentation showing faint yellow spot at the foveal center (indicated by white arrow) in right (a) and left eye (b)|
Click here to view
|Figure 2: Multimodal imaging of both eyes at presentation: (a) Near-Infrared (NIR) image of both eyes with no abnormalities, (b) (FAF) Blue reflectance autofluorescence – showing a circular area of hypo-autofluorescence (indicated by arrowheads) corresponding with the yellow spots of fundus picture, and (c) multicolor images (MCIs) on Heidelberg spectralis) showing subfoveal circular grayish lesions more prominent in the right eye than in the left eye (indicated by black arrows) corresponding to the foveal changes as noted clinically and on autofluorescence picture|
Click here to view
|Figure 3: SD-OCT scan of RE and LE at presentation and at 3rd-month follow-up showing resolution of hyperreflectivity (indicated by a white star) of retinal layers with formation outer retinal micro-holes (indicated by black arrow) and complete resolution of HRF in the left eye and few persistent HRF in posterior vitreous in the right eye (indicated by white arrows)|
Click here to view
|Figure 4: Multimodal imaging at 3rd-month follow-up with (a) Normal NIR image, (b) (FAF) Autofluorescence showing a reduction in the size of a hypo-autofluorescence ring in both eyes (indicated by arrowheads), and (c) MCIs of both eyes showing complete resolution of the subfoveal gray lesion in the left eye with reduction in lesion size in the right eye (indicated by black arrows)|
Click here to view
However, RE scan showed few residual HRF at 3rd month with final acuity of 6/9 when compared with LE where final visual acuity of 6/6 was attained.
Thus, these HRF may be indicative of underlying inflammation and may be helpful in prognosticating these cases. The structural changes at presentation and subsequent recovery were also documented using multimodal imaging including FAF and multicolor images [Figure 4].
| Discussion|| |
Bechmann et al. were the first to describe the structural OCT changes in the cases of solar retinopathy, following which many studies mostly case reports have demonstrated structural alteration in OCT scan.
HRF are well-known OCT markers associated with several retinal conditions and can indicate the underlying inflammatory mechanism. Recently, Nakamura et al. reported the role of steroids in the cases of eclipse retinopathy and proposed an inflammatory basis of retinal damage. Codenotti et al. in their case series mentioned the presence of HRF at the level of vitreoretinal (VR) interface in a single patient on OCT which was taken within 24 h of exposure. Abdellah et al. showed the presence of HRF in inner retinal layers and VR interface in a patient with early OCT scan taken within 1 week of exposure.
| Conclusion|| |
The presence of HRF and hyperreflectivity of retinal layers on OCT scan taken very early (on the same day following eclipse exposure) and their subsequent resolution on follow-up scan correlating with degree visual recovery may support the hypothesis of inflammatory damage as an underlying mechanism in eclipse retinopathy. Although it is a single case study, we hope that this will encourage to undergo studies with larger case numbers.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gass JDM. Stereoscopic Atlas of Macular Diseases. 4th
ed. Missouri: Mosby-Year Book Inc; 1997. p. 411.
Eke T, and Wong SCK, Resolution of visual symptoms in eclipse retinopathy. Lancet, 2001;358:674.
Bechmann M, Ehrt O, Thiel MJ, Kristin N, Ulbig MW, Kampik A, et al.
Optical coherence tomography findings in early solar retinopathy. Br J Ophthalmol 2000;84:547-8.
Kaushik S, Gupta V, Gupta A. Optical coherence tomography findings in solar retinopathy. Ophthalmic Surg Lasers Imaging 2004;35:52-5.
Codenotti M, Patelli F, Brancato R. OCT findings in patients with retinopathy after watching a solar eclipse. Ophthalmologica 2002;216:463-6.
Abdellah MM, Mostafa EM, Anber MA, El Saman IS, Eldawla ME. Solar maculopathy: Prognosis over one year follow up. BMC Ophthalmol 2019;19:201.
Vujosevic S, Torresin T, Bini S, Convento E, Pilotto E, Parrozzani R, et al.
Imaging retinal inflammatory biomarkers after intravitreal steroid and anti-VEGF treatment in diabetic macular oedema. Acta Ophthalmol 2017;95:464-71.
Nakamura M, Komatsu K, Katagiri S, Hayashi T, Nakano T, et al.
Reconstruction of photoreceptor outer layers after steroid therapy in solar retinopathy. Case Rep Ophthalmol Med 2018;2018:7850467.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]