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Eclipse retinopathy
Abstract
Solar retinopathy is a well-recognised clinical entity of macular damage caused by viewing the sun, induced by a photochemical process. The term 'eclipse retinopathy' is frequently employed when the condition is sustained as a result of viewing a solar eclipse. Considerable public excitement had been raised in anticipation of the full solar eclipse on 11 August 1999. Whilst experience has shown that visual morbidity is likely to be temporary, current evidence is anecdotal and restricted to isolated case reports and series. This study was conducted to establish the true visual morbidity associated with a solar eclipse, and whether it was temporary or permanent.
A 3 month active case ascertainment study was carried out from July to September 1999 to record cases presenting to ophthalmologists with visual symptoms arising from solar viewing. Further information about the cases was sought using a short questionnaire. A follow-up questionnaire requesting outcome data at 6 months was also employed.
There were 70 reported cases of visual loss. The average age was 29.5 +/- 12.9 years. Half the cases presented to an ophthalmologist within 2 days of the eclipse. An abnormal macular appearance was reported in 84% of patients at presentation. There have been no reported cases of continued visual loss or symptoms at 6 months.
This is the largest nationwide study of the visual effects of a solar eclipse ever undertaken. There were no recorded cases of permanent visual loss, which corroborates the previous evidence that visual morbidity is likely to be temporary. It would appear probable that public health education was most effective in reducing visual morbidity and hence keeping the consequent burden on the NHS to a minimum.
... Some weeks or months after a solar gazing event, vision often improves significantly, to normal levels [9], but OCT imaging may show persistent changes despite the apparent resolution of clinical signs [10]. Solar retinopathy has long been described in a wide variety of circumstances, including eclipse watching [9], religious rituals [11], sunbathers [12], military gunners [13], pilots, telescopic solar viewing, psychiatric disorders [14] and the use of hallucinogenic drugs [15]. ...
... Some weeks or months after a solar gazing event, vision often improves significantly, to normal levels [9], but OCT imaging may show persistent changes despite the apparent resolution of clinical signs [10]. Solar retinopathy has long been described in a wide variety of circumstances, including eclipse watching [9], religious rituals [11], sunbathers [12], military gunners [13], pilots, telescopic solar viewing, psychiatric disorders [14] and the use of hallucinogenic drugs [15]. While there appears to be just one reported case of FSG as a modality of torture in the medical literature [16], Freedom from Torture has encountered FSG as a method of torture for more than two decades [7,17,18]. ...
Forced solar gazing (FSG) appears to be more regularly employed as a method of torture in certain parts of the world than has previously been documented.
This study is a retrospective analysis of a case set of 17 torture survivors subjected to FSG, who were seen by the UK Charity Freedom from Torture in the period 2009–2019.
All clients in our case set had experienced serious physical and sexual assaults, in addition to the FSG, as part of their mistreatment. All clients suffered with serious psychological conditions as a result of their torture, including depression and post-traumatic stress disorder (PTSD). These mental health conditions made ophthalmic assessment difficult, not simply because of the clients’ associated anxiety, but also because of avoidant behaviour and dissociation which was manifested in the clinical setting. In the two clients who could be examined by an ophthalmologist, both had visible retinal changes and a degree of impairment of visual acuity.
FSG appears to be a method of torture which is regularly employed, and in our case set is seen with other serious manifestations of mistreatment, both physical, psychological and sexual. Psychiatric comorbidities present challenges in the clinical assessment of these cases. Ophthalmic examination can carry a risk of re-traumatisation of individuals who have experienced FSG in a context of torture.
... 1,2 Though rare, numbers of patients presenting with solar retinopathy typically increase fol- lowing a solar eclipse. [2][3][4][5][6][7] Retinal injury as a result of unprotected sungazing occurs in the photoreceptor cells of the fovea and parafovea. It has been suggested that damage occurs secondarily to the disruption of photoreceptor outer segment membranes and mitochondria by oxidative damage as a result of electromagnetic radiation. ...
... 3,8 High definition spectral domain optical coherence tomography (OCT), fluorescein angiography (FA), fundoscopy, and various visual acuity and contrast sensitivity tests are used to determine the severity of retinal damage. [1][2][3][4][5][6][7]9 The vast majority of symptoms resolve within 1-3 months, but there are several documented cases of achromatopsia, central scotoma, and decreased visual acuity remaining 7 months to 1 year after exposure. 7,10 On August 21st, 2017 a solar eclipse occurred within the view of the entire conti- nental USA. ...
Background
Solar retinopathy is a rare ophthalmic disorder resulting from sustained viewing of the sun without protective eyewear. Incidence of solar retinopathy typically increases following a solar eclipse due to attempted visualization of the sun without appropriate eye protection. This paper serves as a case series of all available reported cases of solar retinopathy present in Utah resulting from the August 21st, 2017 solar eclipse.
Methods
Twenty-seven patients had presented with concern for vision changes after the solar eclipse and six patients had exam findings consistent with solar retinopathy. Of these six cases, charts were available for three.
Results
The common finding in all cases was a central scotoma with a correlating change to the inner segment/outer segment junction on optical coherence tomography. Demographically, all three patients were young males.
Conclusion
This data provides insights on populations in Utah at risk for ophthalmic damage and can aid in targeting education programs in the future.
... It is most commonly caused by eclipse gazing (Rosen 1948;Gladstone & Tasman 1978;Aonuma et al. 1999;Ehrt et al. 1999;Thanos et al. 2001). Different clinical manifestations and degrees of visual impairment have been described, and have often improved over time (Rai et al. 1998;Michaelides et al. 2001;Wong et al. 2001). ...
... Thus, we could expect to obtain a more refined evaluation with the above methodology. Solar retinopathy generally improves over time (Rai et al. 1998;Michaelides et al. 2001;Wong et al. 2001) and this proved to be the case with our patients. When compared to our normal subjects, both patients showed some reduction of function on mfERG, which improved over time (Table 1). ...
Clinical investigation of central retinal dysfunction in two cases of solar retinopathy.
Two patients were examined for best corrected visual acuity (VA), fundus inspection, visual fields, multifocal electroretinography (mfERG) with a stimulus pattern of 241 hexagons and, at follow-up, also with optical coherence tomography (OCT).
At the initial examination, mfERG revealed central retinal dysfunction, which had improved by the time of follow-up. In Case 1, a foveal oedema regressed over time, although VA remained slightly reduced. In Case 2, OCT showed spots of increased reflectivity corresponding to the patient's symptoms.
Central retinal dysfunction due to solar retinopathy may improve over time. However, structural and functional changes may persist. This report illustrates that mfERG and OCT are useful tools for objective documentation of the pathology in solar retinopathy.
... Granular cell tumour is a benign neoplasm of a Schwann cell in origin. 1 Rarely this tumor arises in the orbit, skin of the eyelid, palpebral conjunctiva, lacrimal sac, caruncle, and inferior oblique muscle. 2 We report a case of granular cell tumour of the caruncle in an adult patient with mechanical ectropion and immunohistochemical features of this lesion. ...
... However there is often little or no abnormality in solar retinopathy, although in severe cases there may be a window defect caused by retinal pigment epithelium (RPE) atrophy. 2 OCT findings in acute solar retinopathy were first described by Codenotti et al. 4 OCT studies in chronic solar retinopathy describe hyporeflective spaces at the level of the outer photoreceptor segments and RPE. These may involve the entire photoreceptor layer in more severe cases, together with overlying neurosensory thinning. ...
Granular cell tumour is a benign neoplasm of a Schwann cell in origin.1 Rarely this tumor arises in the orbit, skin of the eyelid, palpebral conjunctiva, lacrimal sac, caruncle, and inferior oblique muscle.2 We report a case of granular cell tumour of the caruncle in an adult patient with mechanical ectropion and immunohistochemical features of this lesion.
A 72 year old male patient was evaluated for ectropion of the right lower eyelid, 2 months in duration. Examination revealed a 1 cm, firm, movable, reddish caruncle mass in the right eye associated with ectropion (fig 1A⇓). Computed tomography of the orbit revealed a hyperdense lesion located at the anterionasal side of the globe (fig …
... Solar retinopathy generally improves over time [13,14]. In a large series by Rai et al. [13], 319 patients with solar retinopathy were seen in an eye clinic in Nepal within 20 months. ...
... In another large series by Michaelides et al. [14], 70 patients were reported with transient visual loss due to solar maculopathy. The mean age was 29.5 ± 12.9 years. ...
To evaluate the clinical findings and multifocal electroretinography results of cases with solar maculopathy due to eclipse watching.
Eight eyes of six patients (ages ranged 12-42) who presented to our clinic after the solar eclipse of 29 March 2006 were evaluated in the study. All patients underwent a full ophthalmologic examination and multifocal electroretinography (mfERG).
Visual acuities at the initial examination were between 20/32 and 20/20; and at final examination between 20/25 and 20/20 respectively. Fundoscopic examination disclosed macular pigmentary changes in almost all patients. Fundus Fluorescein Angiography revealed a window defect in six eyes. The initial findings of the mfERG at the first visit showed a decrease in the P1 and N1 amplitudes of the central responses. The following mfERG recordings showed a recovery in central P1 and N1 amplitudes.
Decrease in P1 and N1 amplitudes of central macular region can be detected by mfERG in patients with solar maculopathy. Follow-up mfERG test results may recover with the increase of visual acuity.
... Solar retinopathy develops mainly through photooxidation [13]. The mechanism involves changes in photoreceptor membranes and alterations in RPE function due to excess solar radiation absorption by melanin [6,14]. ...
... Observing solar eclipse without proper protection may damage eyes. Michaelides et al. (2001) conducted active case study in England during July-September 1999 to assess the damage to retina due to viewing of the last solar eclipse of the third millennium. There were 70 reported cases of visual loss (average age 29.5±12.9 ...
This paper addresses health issues associated with the observations of solar eclipses, in particular, eclipse retinopathy due to observation of partial-solar eclipses without proper protection to eyes. Partial-and total-solar-eclipse expeditions conducted by the author during 1995-2008 are described. Violation of Kepler's second law of planetary motion was witnessed during the 1995 total-solar-eclipse expedition and the same was confirmed during the 1999 total-solar-eclipse expedition. During the 1995 expedition, seconds before the end of totality, the black circular disc changed into an elliptical shape of eccentricity 0.26, with the major axis vertical to horizon. Safe viewing of eclipse is recommended through special glasses made from 2 layers of completely exposed ASA 100 film as well as UV-cutoff glasses.
... Intentional staring at the sun causes eye injuries, as is reported after solar eclipses. 6,7 However, continuous viewing of the blue sky, certainly in the UK, does not present a risk of eye injuries. Comparing natural exposures with the reasonably foreseeable exposure to optical radiation from lamps, computer screens and mobile devices, such as smartphones shows that the actual spectrally weighted irradiance is lower than the natural exposures. ...
The introduction of low energy lighting and the widespread use of computer and mobile technologies have changed the exposure of human eyes to light. Occasional claims that the light sources with emissions containing blue light may cause eye damage raise concerns in the media. The aim of the study was to determine if it was appropriate to issue advice on the public health concerns. A number of sources were assessed and the exposure conditions were compared with international exposure limits, and the exposure likely to be received from staring at a blue sky. None of the sources assessed approached the exposure limits, even for extended viewing times.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763136/pdf/eye2015261a.pdf
Eye (2016) 30, 230–233; published online 15 January 2016
... The common presenting symptoms of solar retinopathy include decreased visual acuity, metamorphopsia, micropsia, photophobia, after image, scotoma, and headache. 14,15 The classical presentation of eclipse retinopathy is a small foveolar lesion yellow white in colour. The lesion fades over a period of 2-4 weeks and is replaced by a depression or partial thickness hole. ...
Solar observa on and eye damage is known for centuries. Unprotected eclipse viewing is the leading cause of solar re nopathy. Inspite of using commercially available cer fi ed solar fi lters, use of binoculars, exposed photographic fi lm and X-ray fi lm are common unsafe prac ce of eclipse viewing. Public awareness by media campaigns about the appropriate protec ve measures while viewing an eclipse is the mainstay in the preven on of this disease. The natural course of solar re nopathy is to show resolu on and visual improvement, but use of an-infl ammatory drugs hastens the recovery. We report a case of young male with acute solar re nopathy a er viewing solar eclipse. The pa ent was successfully treated with cor costeroids with complete visual rehabilita on. Del J Ophthalmol 2012;23(4):285-287.
... In Europe, considerable public excitement arose in anticipation of the full solar eclipse on 11 August 1999. Most people remember the fact that exposure to intense light is a threat to the eye when they prepare for watching a solar eclipse (Michaelides et al., 2001). People were urged not to look directly into the sun with unprotected eyes because this can result in visual morbidity. ...
The photoreceptors in the retina, designed to initiate the cascade of events which link the incoming light to the sensation of 'vision', are susceptible to damage by light, particularly blue light. The damage can lead to cell death and diseases. The turnover of retinal, an essential element of the visual process, is the basis of the events that lead to damage. Free retinal, absorbing in the blue region of the visible spectrum, is phototoxic, and is a precursor of the (photo)toxic compound A2E, which specifically targets cytochrome oxidase and thereby induces cell death by apoptosis. Cell death induced by A2E in the dark is prevented by negatively charged phospholipids. The blue light-filtering molecules lutein and zeaxanthin are tailor-made substances protecting the retina. In vitro, they protect cytochrome oxidase against the permanent damage caused by A2E in combination with light. These novel findings should enable us to prevent or cure the dry form of age-related macular degeneration, the leading cause of severe visual impairment in humans living in developed countries.
Solar retinopathy (SR) refers to retinal injury that results from unprotected excessive exposure to light. It has been associated with direct sungazing, sunbathing, laser pointers, and welding arc exposure. Symptoms are typically bilateral and are characterized by asymmetric decreased vision, central or paracentral scotoma, photophobia, metamorphopsia, and headache. In most cases, recovery occurs spontaneously with no specific treatment within weeks to 6 months after exposure. However, few cases have been reported in the literature using steroids in acute SR because of their anti-inflammatory effects. The aim of this review is to present an update about this entity, describing the pathogenesis, risk factors, and diagnostic methods, with focus on management and outcomes of SR.
Background Solar and laser-associated retinopathies are rare occurrences. The two retinopathies are both photo-induced but differ in the involved intensity and duration of exposure. The purpose of this study was to evaluate the clinical features and natural course of these two entities, with a focus on the changes in the outer retina over time.
Patients and Methods This retrospective analysis assessed patients with solar or laser maculopathy seen at the Department of Ophthalmology of the University Hospital Zurich in Switzerland over the last 10 years. Visual acuity (VA; Snellen) and optical coherence tomography (OCT) findings were reviewed and analyzed at baseline and last follow-up visit. Areas of damaged outer retina, identified on en face OCT images as hyporeflective areas, were tagged and compared between visits. Descriptive analysis was performed by calculating mean values ± standard deviation (SD). Statistical evaluation was done using the Wilcoxon signed rank test. A p value < 0.05 was considered statistically significant.
Results Five patients with solar retinopathy and six patients with laser-associated retinopathy were identified. In the solar retinopathy group, mean VA at baseline was 0.80 (SD ± 0.37) and improved to 0.90 (SD ± 0.36). This was not statistically significant (p = 0.066). In the laser-associated retinopathy group, mean VA at baseline was 0.89 (SD ± 0.18) and improved to 1.03 (SD ± 0.09), which was not statistically significant either (p = 0.063). At baseline, in OCT cross-sections, initial changes were observed in the interdigitation, myoid, and ellipsoid zone, as well as the outer nuclear layer and the Henle fiber layer. At follow-up, most cases presented an alteration in the residual ellipsoid zone, with the degree of the aforementioned alterations depending on the size of the initial defect. A decrease of the hyporeflective alterations measured in en face OCT scans was observed in both groups but was only statistically significant in the laser-associated retinopathy group (p = 0.018 versus p = 0.172).
Conclusions OCT can help to detect and monitor solar and laser-associated retinal injuries. Most injuries are minor, with good functional restitution. Minor changes in the ellipsoid zone often persist, even in cases with full visual recovery.
Virtual reality (VR) introduces new approaches to creating virtual spaces for empirical studies and design processes. At the same time, VR platforms for research and education purposes in the field of daylight, such as one being built at TU Berlin, have to consider technical limitations. Besides the imperfections caused by simulation tools, VR head mounted displays (VR HMDs) bring additional shortcomings, one of the most obvious being the low maximum luminance compared to daylight. However, considering a typical viewing distance within VR HMDs is about 15 mm, and a usage duration can last up to 8 hours or more, concerns have arisen about the safety of displays with high luminance levels, particularly as a prototype claiming a maximum luminance of up to 6 000 cd/m ² has been introduced in the last years. Therefore, this paper compares the blue light hazard (BLH)-weighted radiances of VR HMDs to given exposure limits provided by the ICNIRP guidelines on limits of exposure to incoherent visible and infrared radiation and by the IEC 62471 (photobiological safety of lamps and lamp systems). The paper concludes with a statement on the BLH safety of VR HMDs.
Introduction. Eclipse retinopathy occurs due to unprotected viewing of a solar eclipse. It is a long-recognized condition. The damage inflicted to the macula is due to a photochemical and photothermal effect caused by sunlight that enters the eye and is focused by the crystalline lens. Animal studies into eclipse retinopathy have been previously carried out. Retinal irradiance levels leading to macular damage have been established in rabbits. Limited data from studies on primates are also available. However, the exact values for humans have not yet been established with confidence.
Methods. Here we present a simple method for estimation of the retinal irradiance dose in humans and a classification of macular damage.
Results. As an example, the retinal irradiance dose of a theoretical patient observing the solar eclipse of March 20, 2015, is given along with the grade of macular damage according to the developed classification.
Discussion. The retinal irradiance values given in the classification are provisional for the time being. With more widespread use among ophthalmologists the developed classification should become useful for prognostic purposes.
Solar maculopathy occurs as a result of the effects of exposure of the macula to the harmful light spectrum from the sun. Phototoxic damage of the macula occurs as a result of the exposure to sunlight with some resultant visual deficit. The effect is common during a solar eclipse, where people directly watch the occurrence without sun-filter glasses. Solar maculopathy is also known to occur during religious rituals, and in schizophrenic patients who stare at the sun. Clinical history, subtle clinical biomicroscopic, and optical coherence tomography (OCT) findings are the key in making a diagnosis. Management is conservative with OCT follow-up. Solar maculopathy from nondeliberate sun gazing is not common. We report the case of a 24-year-old African who developed solar maculopathy after nondeliberate exposure to sunlight.
The international lamp safety standard IEC 62471 “Photobiological safety of lamps and lamp systems” defines criteria to classify lamps into one of four risk groups (exempt, RG1, RG2, RG3). RG3 is referred to as “high risk” and is usually not considered as appropriate as a consumer product unless made safe by the housing (the luminaire or the lamp system). While the exempt group and RG1 is usually accepted as “safe”, there are concerns – particularly for LEDs – if RG2 is appropriate for lighting of rooms or streets, or as consumer products without a warning label. To support a balanced view of the actual risk associated to the use of a product, this paper discusses the rules of how to determine the risk group. Strictly speaking IEC 62471:2006 requires risk group classification only for lamps and not for luminaires or lamp systems. Due to different reasons, the risk group might not reflect the actual risk: small assumed eye movements, wide ranges of permitted exposure durations per risk group as well as safety margins between limits and injury thresholds. For lighting and many other applications, for instance, RG2 when associated with visible light emission can probably be considered as sufficiently safe for consumer products even without warning labels. When UV emission is not an issue, it can be argued that for regular lamps and luminaires, risk group classification does not appear to be necessary. We also argue that it is not justified to consider LEDs differently than other, conventional light sources in a discussion about retinal hazards.
Purpose
We report a case of bilateral solar retinopathy following the Great American Eclipse on August 21, 2017. We summarize findings on multimodal imaging and risk factors associated with solar retinopathy.
Methods
A teenage boy presented with painless vision loss 4 days following viewing a total solar eclipse. Funduscopic examination, optical coherence tomography, and fluorescein angiography revealed findings characteristic of solar retinopathy. Multifocal electroretinography was also performed. We add to the literature the first reported case of solar retinopathy following the Great American Eclipse.
Results
The patient was observed with serial examinations over several weeks. Gradual trend toward visual recovery was noted on imaging.
Conclusions
In combination with clinical history of sungazing and funduscopic examination, distinct findings on imaging help secure a diagnosis of solar retinopathy. Visual symptoms in solar retinopathy generally improve over time. Appropriate protective measures with counseling and filtered eyewear are recommended for eclipse viewers.
Unprotected and prolonged exposure to ultraviolet (UV) light from sunlight, lasers, and arc welding leads to outer retinal damage. The photoreceptors and retinal pigment epithelium located in the posterior pole are particularly susceptible to this radiation. Classically known as solar retinopathy, this disorder frequently affects young individuals who have clear lenses and a propensity toward observing solar eclipses. Various imaging techniques aid the clinician in diagnosis, even if patients cannot recall an exposure event. By far the most utilized technique is optical coherence tomography, which, in tandem with fluorescein angiography, and fundus autoflourescence, is crucial in ruling out other conditions. Fortunately, the prognosis of acute UV retinopathy is favorable, as most cases fully recover; however, a significant percentage of patients suffer from chronic sequelae: reduced acuity and lifelong central/paracentral scotomas. Thus, education towards understanding UV exposure risks, coupled with either abstinence or proper eye protection, is critical in preventing macular damage. We outline the various etiologies responsible for UV induced retinopathy, describe the limited treatments available, and provide recommendations to minimize the potential devastating ophthalmic consequences as our society increases its reliance on UV-emitting technology and further engages in solar eclipse viewing.
Background
Solar retinopathy refers to damage to the central macula caused by exposure to intense solar radiation, most frequently observed after a solar eclipse.
Objective
Description of the morphological changes in spectral domain optical coherence tomography (SD-OCT) and the clinical course in patients with acute solar retinopathy.
Material and methods
The study included a retrospective analysis of 12 eyes from 7 patients with solar retinopathy after the partial solar eclipse on 20 March 2015. Best corrected visual acuity, fundus changes and SD-OCT findings were analyzed. Out of the 7 patients 5 underwent treatment with 1 mg prednisolone per kg body weight.
Results
The average age of the patients was 30.1±13.1 years. Best corrected visual acuity was 0.65 at initial presentation. In the acute stage all affected eyes showed a small yellowish lesion in the centre of the fovea in the fundoscopic examination. In SD-OCT the continuity of all layers in the foveola appeared disrupted. In the follow-up examination these changes were partially resolved. After 2 months SD-OCT revealed a small defect of the ellipsoid zone. In one patient the defect could not be shown due to slightly excentric imaging sections. Best corrected visual acuity increased to 0.97.
Conclusion
The SD-OCT is an appropriate tool to determine the exact localization of the site of damage and for follow-up examination in solar retinopathy. In the acute phase it shows a disruption of the continuity of all layers in the foveola. Despite good recovery of visual acuity a small central defect of the ellipsoid zone remains in the long term.
• The sunglasses play an essential role in protecting specific eye diseases and visual function deficient. The paper, systematically and completely, discusses about the protecting of eye diseases and visual function deficient while using sunglasses. The analysis about the requirements of how to avoid the secondary hazards by impeding vision or by causing injury due to sunglasses-wearing is fully discussed.
Case report: We present the evolution of eclipse retinopathy in 3 patients who came to our hospital after the eclipse of October 2005 and had foveal lesions and visual field alterations. Discussion: Eclipse retinopathy is a maculopathy that occurs after exposure to intense solar radiation, such as occurs during an eclipse, and is produced by a photochemical mechanism. Although the macular changes and symptoms are usually reversible, residual defects at the level of the EPR and scotoma in visual fields can occur. For these reasons the most appropriate treatment is prevention by means of public awareness campaigns (Arch Soc Esp Oftalmol 2007; 82: 575-578).
To present the visual outcome of patients with solar retinopathy and evaluate the effects of treatment on the visual prognosis. One hundred and eighty-eight patients with visual disturbances applied for ophthalmic examination following the solar eclipse on August 11, 1999. All patients underwent routine ophthalmologic examination; those with fundus changes also underwent fundus fluorescein angiography, Amsler grid and computerised perimetry. Among them, nine patients (11 eyes) were evaluated as having solar retinopathy with decreased visual acuity and discernible fundus findings. Mean age was 21.5 (17-34) in this group. Five patients were given treatment, three were on oral methyl prednisolon and two were on ginkgo glycosides. Statistical analysis could not be performed because of the small number of patients in the treatment groups. The duration of exposure was 1-30 min. The mean initial visual acuity was 20/32 (min 20/100, max 20/25). All eyes aside from one revealed positive Amsler grid tests. Computerised perimetry showed central scotoma in four eyes. The mean visual acuity at final examination (3 months later) was 20/24 (min 20/50, max 20/20). Metamorphopsia persisted in five eyes, and disability at near vision persisted in one eye after 3 months. Early and late fundoscopic findings did not correlate with either duration of exposure or visual acuity. Reversible or persistant visual abnormalities may follow a solar retinal burn. Prevention seems to remain the best treatment. Corticosteroids may be beneficial in severe cases.
Photochemical/thermal retinal damage that results from unprotected solar eclipse viewing has vague presentations and sometimes misleading diagnosis, especially in cases with unclear history. Spectral-domain optical coherence tomography (SD-OCT) is a non-invasive imaging technique useful in differential diagnosis that can reveal characteristic foveal alterations in solar retinopathy to an unprecedented quasi histologic level. The authors present high-resolution SD-OCT findings correlated with clinical findings in three eyes of two cases with acute solar retinopathy. SD-OCT can precisely define the site and extent of damage in acute solar retinopathy. In mild forms, damage may be limited to the outer retina with inner segment/outer segment disruption. In severe forms, full thickness macular damage may be seen. Advances in retinal imaging have improved our ability to provide precise correlation with clinical presentation and prognosis.
Sunglasses and sunglass standards are reviewed from the point of view of the history of sunglasses and the development of sunglass standards. The need for eye protection from solar radiation is discussed and the provisions of the various national sunglass standards are discussed in relation to that need.
Solar retinopathy is characterized by involvement of the outer retinal layers. Optical coherence tomography may help delineate the retinal injury site in vivo. Optical coherence tomography was performed in three eyes of two patients with solar retinopathy. All three eyes demonstrated a characteristic excavation in the outer hyperreflective layer corresponding to the retinal complex.
The commonest cause of solar retinopathy is direct viewing of a solar eclipse.1 Other associations include sun gazing during religious rituals, drug or alcohol intoxication, and mental illness.2,,3 However, it may not be considered in the absence of a history of sun gazing. We report an unusual case of solar retinopathy in a patient with bipolar affective disorder and demonstrate the value of optical coherence tomography in aiding the diagnosis in cases of unexplained visual loss in patients with mental illness.
A 45 year old woman presented complaining of a gradual deterioration in vision over 3 years. Past medical history included hypothyroidism and bipolar affective disorder treated with antidepressant and antipsychotic medication.
Presenting visual acuities were 6/12 in the right eye and 6/9 …
Case report:
We present the evolution of eclipse retinopathy in 3 patients who came to our hospital after the eclipse of October 2005 and had foveal lesions and visual field alterations.
Discussion:
Eclipse retinopathy is a maculopathy that occurs after exposure to intense solar radiation, such as occurs during an eclipse, and is produced by a photochemical mechanism. Although the macular changes and symptoms are usually reversible, residual defects at the level of the EPR and scotoma in visual fields can occur. For these reasons the most appropriate treatment is prevention by means of public awareness campaigns.
Short-wavelength visible light (blue light) of the Sun has caused retinal damage in people who have stared fixedly at the Sun without adequate protection. The author quantified the blue-light hazard of the Sun according to the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines by measuring the spectral radiance of the Sun. The results showed that the exposure limit for blue light can be easily exceeded when people view the Sun and that the solar blue-light hazard generally increases with solar elevation, which is in accordance with a model of the atmospheric extinction of sunlight. Viewing the Sun can be very hazardous and therefore should be avoided except at very low solar elevations.
This paper is the report of a series of young adult patients who developed solar retinopathy over a 2-day period in the spring of 1986 in a particular region of the United States. These patients had a history of sun exposure, without direct sun viewing. None was predisposed to solar retinopathy because of any other known risk facter except for age and refractive state of the eye. Several governmental scientific agencies provided geophysical data which were analyzed in an attempt to explain the chorioretinal radiational effects noted in these patients. Certain geophysical changes present during this 2-day period were investigated as possible risk factors in the pathogenesis of retinal damage present in these patients with solar retinopathy. On the basis of the photobiological and geophysical analysis of these cases, a multifactorial hypothesis for the pathogenesis of solar retinopathy is presented.
Nearly a decade aga a general review article on the evaluation of optical radia tion hazards was published in Applied Optics (Sliney and Freasier, 1973). This arti cle received many favorable comments but also prompted many inquiries regarding specific optical hazard problems. From this it became evident that a monograph rather than a supplemental and expanded article was needed to fill this literature gap relating to laser and optical radiation hazards. The present work is designed to fill that gap, and is structured to permit either classroom or self-study use. Much of the material in this book was developed in eonnection with short courses on laser safety and radiometry in which we have participated, as weIl as from our previous articles. In particular, the sequenee of chapters is based upon the experiences which we have had in lecturing in courses with different schedules. One of the great difficulties in developing a text of this nature is that a broad, multidisciplinary background must be included in order that the reader can comprehend all of the subjeet matter readily. For this reason, the material presented on anatomy and physiology is orien ted toward the engineer or physical scientist, while the review material on basic optical physics is intended more for the physician or life scientist.
Observing the Sun can be dangerous, and looking at the Sun through an
optical aid without adequate precautions, or even with the naked eye,
can result in permanent damage to the eye(s). Probably all professional
astronomers and most amateur astronomers are aware of the danger but the
general public is not. Further, it is not easy to find authoritative
guidance on how to observe the Sun in safety. This article discusses the
problem and dangers, and suggests which precautions may be considered
reasonably safe.
The visual disturbances caused by looking into the sun or a solar eclipse have been known for many years. Recently, there have been discussions about whether or not solar retinopathy is a distinct clinical entity or identical to the disease termed foveomacular retinitis. A series of 36 patients has been evaluated at Letterman Army Medical Center with the ophthalmoscopic appearance compatible with both conditions in various stages of the disease. By use of clinical history, funduscopy, visual fields, Amsler Grid, color acuity testing, color fundus photography, and fluorescein dye studies, it is our distinct impression that these two conditions are identical.
Methylprednisolone (MP) has been prescribed for the treatment of solar retinopathy presumably because of its anti-inflammatory effect. Recently, high doses of MP have been shown to ameliorate light-induced photoreceptor degeneration, and the mechanism of action was suggested to be the inhibition of lipid peroxidation. In this study we examined the dose-response effect and the effect of delayed treatment with MP in an established rat model of retinal photic injury. Animals received intraperitoneal injections of either MP (8, 160, or 320 mg/kg/day) or saline solution (as a control) for 2 days. Injections were started simultaneously with the commencement of light exposure or delayed for 6 or 24 h. The animals were sacrificed 6 days after light exposure, and the retinal damage was assessed by light microscopy and morphometric measurement of the outer nuclear layer (ONL) thickness. Morphologically and morphometrically, treatment with 8 mg/kg/day of MP was not effective, while treatment with 160 mg/kg/day caused better preserved photoreceptors and a thicker ONL compared with the controls (P less than 0.001). Animals administered with a dose of 320 mg/kg/day showed more severe damage to photoreceptors, resulting in a thinner ONL (P less than 0.05). When treatment with 160 mg/kg/day was delayed for 6 h, a similar efficacy as in the no-delay group was noted, but when treatment was delayed for 24 h, no beneficial effect was observed (P = 0.19). Our results demonstrated that early treatment with high doses of MP ameliorated retinal photic injury in rats.
Macular lesions of solar retinopathy observed in a psychiatric hospital population are described. These lesions appeared similar to those resulting from Xenon lamp coagulation, accidental laser injury, and exposure to intensive illumination of nuclear bomb detonation. Characteristically, the lesions appeared as one or several adjacent, circumscribed retinal holes, each with a white halo and surrounding pigment alteration. Retinal edema, present only in the more acute cases, seemed to be associated with poor vision. In view of the large macular lesions found, retention of good visual acuity was surprising. There appeared to be a rough correlation between lesion size and visual acuity, except when retinal edema affected visual acuity.
During a two-year period, 47 patients with the entity known as foveomacular retinitis were examined. Twenty-four of 35 patients, or 69%, admitted to sun gazing prior to the onset of symptoms. The foveal lesions in patients who admitted to or denied sun gazing were identical. Based on these findings, we have concluded that foveomacular retinitis does not exist as a distinct entity, but is, indeed, a solar burn of the fovea, self-inflicted for the purpose of secondary gain or associated with the use of drugs.
The purpose of this paper is to report a distinct type of macular disease involving primarily the fovea, occurring in young individuals, involving usually both eyes, and resulting in permanently impaired central vision. This type of foveomacular disease was reported first by Cordes1 and later by Harrington.2 Because of the scarcity of information in the literature on this subject, we wish to refocus interest on the disease. In contrast to the two earlier reports, we differentiate this particular foveomacular disease from central serous detachment of the macula.
This report is based on the clinical findings in 18 patients examined by us at the US Naval Hospital, San Diego, Calif, between January 1964 and January 1966. The military personnel were hospitalized during the course of their illness. Fifteen were recruits stationed at the Marine Corps Recruit Depot or at the Naval Training Center in San Diego. The duration of
1. 1. Environmental factors associated with eclipse retinitis epidemics were enumerated. 2. 2. The retinal changes of solar retinitis were classified into three ophthalmoscopically separate stages. 3. 3. Comparison of initial vision and the visual acuity six months posteclipse revealed that the visual prognosis was almost always better than 20 50. 4. 4. In the involved eyes followed for six months, whether or not protection was claimed to have been used and whether or not systemic steroids were administered, the chance of recovery of 20 20 visual acuity was approximately 50%. 5. 5. Prior existing muscle imbalance or amblyopia resulted in the solar retinitic lesion being generated in the dominant eye. 6. 6. The absence of retinal burns in severely ametropic eyes was noted. {A table is presented} 7. 7. No increased incidence of solar burn was detected in deeply pigmented eyes or heavily pigmented individuals. 8. 8. Various forms of ineffective protective measures were catalogued.
Samples of protective filters commonly used to observed the partially eclipsed sun were obtained and subjected to spectrophotometric analysis over the wavelength interval 330 to 2500 nm. Performance of these filters was compared with criteria for adequate ocular protection which have appeared in the literature. It appears that the greatest safety is provided by those devices incorporating a monatomic metallic coating as the filtering agent.
This study documents the ultrastructural findings in a case of solar retinopathy, 6 days after sungazing. A malignant melanoma of the choroid was diagnosed in a 65-year-old man. On fundoscopy, the macula was normal. The patient agreed to stare at the sun prior to enucleation. A typical solar retinopathy developed, characterised by a small, reddish, sharply circumscribed depression in the foveal area. Structural examination of the fovea and parafovea revealed a spectrum of cone and rod outer segment changes including vesiculation and fragmentation of the photoreceptor lamellae and the presence of discrete 100-120 nm whorls within the disc membranes. Many photoreceptor cells, particularly the parafoveal rods, also demonstrated mitochondrial swelling and nuclear pyknosis. Scattered retinal pigment epithelial cells in the fovea and parafovea showed a degeneration characterised by loss of plasma membrane specialisations, swelling of the smooth endoplasmic reticulum and changes in the fine structure of the lipofuscin granules. The good visual prognosis in solar retinopathy was attributed to the resistance of the foveal cone cells to photochemical damage.
Solar retinopathy was observed in a total of 86 eyes of 58 patients following the solar eclipse over Turkey in April 1976. The visual prognosis and the presence of late complications were evaluated at the early and late periods.
Of the 58 patients, 34 (51 eyes) presented during the first week and came for follow-up examination in the succeeding week, also after 1, 3, 12, and 18 months. After that they were examined at yearly intervals (mean 4.2 years). Twenty-four patients (35 eyes) presented during the period between 1 and 11 years post-eclipse and were followed up for a mean period of 3.4 years. After a period of 15 years, all of the patients were invited for re-examination and nine patients (14 eyes) attended.
The improvement in visual acuity was observed to have taken place mostly during the first 2 weeks to 1 month after the eclipse. Further improvement in visual acuity was not observed in any of the eyes after the 18-month examination. The improvement in visual acuity was more prominent and earlier in the eyes that had visual acuity of 0.2 or better initially. Only the eyes with initial visual acuity equal to or better than 0.4 had a chance to improve their acuity to 10/10. Having observed the 51 eyes for mean period of 4.2 years and the 35 eyes for 3.4 years, no change in visual acuity was observed. Among the total of 86 eyes, 9 were found to have pseudolamellar macular holes.
Correlation was found between initial visual acuity and the funduscopic appearance after the 2nd week. Fluorescein angiography was not found to be a conclusive test in solar retinopathy. No late complications were observed.
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