Solar Maculopathy

Solar Maculopathy
SYMPTOMS Decrease in central vision, Central scotoma, Metamorphopsia
Visual symptoms occur within 1-4 hours of UV exposure
SIGNS Typically bilateral
Signs of solar maculopathy may take hours to days to first appear
Initially starts as a yellow-white lesion in the fovea region that turns red in 2-4 weeks. Other signs include Faint gray pigmentations, RPE clumping, and RPE hypopigmentation
WORK-UP Full eye exam with dilated retinal exam, OCT analysis of the macula (signs of solar maculopathy are best seen with an OCT): Hyperreflectivity of all retina tissue at the fovea/foveola within 48 hours. Eventually a cavitation of the ellipsoid zone and interdigitation zone will develop. The ELM and RPE will typically remain intact, Fluorescein Angiography, Fundus Autofluorescence, Fundus photos, Infrared retinal imaging, Watzke-Allen test, Macular photostress test, Amsler grid
TREATMENT There is no known treatment available
FOLLOW-UP See patient back in 1-2 months for the first 6 months (recovery is spontaneous and typically occurs over a 3-6 month period)
ETIOLOGY Photoreceptor damage at the fovea and foveola secondary to photochemical and thermal toxicity of the retinal tissue especially at the level of the RPE
DIFFERENTIAL DX Macular hole, Cone dystrophy
NOTES The most common cause of solar maculopathy is sun gazing or looking at a solar eclipse
Mild presentations of solar maculopathy may not show any fundus abnormalities
Solar Maculopathy: OCT of the macula demonstrating hyperreflectivity of retinal tissue at the foveola which is typically seen within the first 48 hours of UV exposure