Description
A 62-year-old Indian male presented with complaints of minimally blurred vision in both eyes since 3–4 months. He was a known case of essential hypertension. On ocular examination, best corrected visual acuity was 20/40 in both eyes with a +4D spherical correction. Anterior segment evaluation revealed immature senile cataract with normal intraocular pressures. On fundus examination, a discrete yellow dot was noted at the fovea of both eyes (right > left), along with features of early hypertensive retinopathy (figure 1). He was diagnosed to have outer lamellar macular hole in both eyes. Spectral-domain optical coherence tomography (OCT) revealed hyporeflective space in outer retina at the foveal centre of both eyes (right > left) (figure 2). A diagnosis of solar retinopathy was considered and on leading questions, he gave a history of performing religious rituals involving direct gazing into the rising sun soon after dawn for 5–10 min daily. He had been doing this for the past 30–35 years.
Figure 1.
Fundus photograph of the (A) right and (B) left eyes showing a yellow dot at the foveal centre. There are other features of early hypertensive retinopathy and the left eye has minimal tortuosity of retinal vessels.
Figure 2.
Spectral-domain optical coherence tomography vertical line scans of the macula of the (A) right and (B) left eyes showing hyporeflective space in the outer retina at the foveal centre. There is disruption of the interdigitation and the ellipsoid zones, while the rest of the internal retinal architecture is maintained.
Solar retinopathy is a photic retinopathy occurring after direct exposure to sunlight. It is typically associated with viewing of the solar eclipse and religious sun gazing, and is also described following sunbathing, telescopic solar viewing, psychiatric disorders and psychotropic drugs.1 Presentation occurs within a few hours of exposure with impairment of the central visual function. Quantitative visual acuity can be variable depending on the severity of damage. OCT features of the outer retina, as seen in our patient, are very crucial for the diagnostic suspicion as clinical findings are generally subtle and may be easily missed.2
The visual prognosis of solar retinopathy is usually favourable, probably due to the resistance of foveal cones to photochemical damage, and in most cases the visual loss is at least partly reversible.3 As it is an easily avoidable condition, prevention is of utmost importance. Therefore, awareness and sensitisation of people to this condition is required. Since the pathogenesis involves chemical reactions, the direct, prolonged and chronic exposure to sunlight made our patient vulnerable to the disease.
Learning points.
Optical coherence tomography features are very useful in diagnosis of solar retinopathy as clinical features are usually of subtle nature. Typical outer retinal changes should arouse suspicion and indicate leading questions for history of exposure to sunlight.
The condition is easily preventable and awareness should be created specifically in areas where such religious rituals are common.
Footnotes
Contributors: AS, BT and ST performed imaging and workup of the patient. AS and BT wrote the manuscript, PV critically revised it. PV holds the overall responsibility of the paper.
Competing interests: None declared.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
- 1.Yannuzzi LA, Fisher YL, Krueger A, et al. Solar retinopathy: a photobiological and geophysical analysis. Trans Am Ophthalmol Soc 1987;85:120–58. [PMC free article] [PubMed] [Google Scholar]
- 2.Kaushik S, Gupta V, Gupta A. Optical coherence tomography findings in solar retinopathy. Ophthalmic Surg Lasers Imaging 2004;35:52–5. [PubMed] [Google Scholar]
- 3.Mainster MA, Turner PL. Photic retinal injuries: mechanisms, hazards, and prevention : Ryan SJ, Ryan SJ, Retina. 5th ed china: Elsevier:1555–63. Chapter 90. [Google Scholar]