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SYMPTOMS
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Blurry vision, Scotomas, Visual field loss, Metamorphopsia
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SIGNS
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Typically unilateral
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Typically unilateral Acute signs: Well defined areas of retinal whitening with a glistening appearance without retinal vasculature disruption (Typically found in the inferior temporal or temporal quadrants of the retina), Hemorrhages (intraretinal, subretinal, preretinal, intravitreal)
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Late signs: Areas of RPE disruption and hyperpigmentation, Loss of photoreceptors, Possible lamellar or full thickness macular hole
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Commotio retina involving the posterior pole is called Berlin’s edema
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Other ocular signs of trauma may be present as well including corneal scars, iridodialysis, traumatic cataract, optic atrophy, etc
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WORK-UP
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Pupils | EOMs | Full eye exam with dilation | Gonioscopy (Typically done 4-6 weeks post-trauma) | Amsler grid
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OCT (Hyper-reflectivity and thickening of the ellipsoid zone) | OCT-Angiography | Fundus autofluorescence | Fundus photos | Infrared photos | B-scan ultrasound in the presence of an intravitreal hemorrhage
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TREATMENT
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Give Amsler grid especially if commotio retinae involves the macula | Well-defined areas of retinal whitening typically resolve in 4-7 days. The majority of patients will experience a full recovery but it may take a few months (Photoreceptor outer segment recovery starts at about 1 week after the ocular trauma and continues over a 2 month period)
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If there is no macula involvement, monitor.
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If there is a macular hole, refer to retinal specialist for further evaluation and treatment
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FOLLOW-UP
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If monitoring, follow up in 1-2 weeks. If stable with no signs of macular hole, monitor in 1 month
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ADDITIONAL LAB | TESTS
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None, although lab tests such as orbital CT may be ordered for other ocular complications associated with trauma
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ETIOLOGY
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Photoreceptor outer segment and RPE damage secondary to direct or indirect trauma to the eye. Contrecoup trauma is the most common etiology.
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Areas of retinal whitening is most likely due to extracellular swelling of the photoreceptors. Glistening appearance is most likely due to light scatter by abnormal photoreceptors and subretinal debris
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DIFFERENTIAL DX
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Retinal detachment, White without pressure, Chorioretinitis sclopetaria
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NOTES
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If commotio retinae involves the macula, there is an increased risk of permanent vision loss that is worse than 20/30 (26% of patients with macular involvement)
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