Major Article
Solar retinopathy in children

https://doi.org/10.1016/j.jaapos.2015.05.009Get rights and content

Purpose

To describe the visual acuity, fundus appearance, and spectral domain optical coherence tomography (SD-OCT) findings in 5 eyes of 3 children with foveal damage from solar retinopathy.

Methods

This was a prospective, observational case series of children who presented to the emergency department at the Royal Victorian Eye and Ear Hospital after having directly viewed the Sun during the transit of Venus on June 6, 2012, or the partial eclipse of the Sun on November 14, 2012. All patients underwent visual acuity testing, dilated fundus examination, and SD-OCT imaging.

Results

The 3 patients' ages at presentation were 8, 10, and 11 years. Best-corrected visual acuity in the affected eyes ranged from 20/20 to 20/40 on presentation. Significant foveal pathology was identified on SD-OCT in all 5 eyes, even when visual acuity was normal. At presentation, all eyes showed disruption of the photoreceptor ellipsoid zone and the interdigitation zone on SD-OCT. Additionally, in those eyes with decreased visual acuity, there was disruption of the outer nuclear layer and/or external limiting membrane. At 3-5 months’ follow-up, the outer nuclear layer and external limiting membrane lesions had resolved; however, in some eyes the ellipsoid and interdigitation zone abnormalities persisted at 5 months’ follow-up, even in the presence of best-corrected visual acuity as good as 20/12.5.

Conclusions

Solar retinopathy in children can cause persistent damage to multiple retinal layers despite recovery of good visual acuity.

Section snippets

Subjects and Methods

In this prospective, observational case series, children who presented to the Emergency Department at the Royal Victorian Eye and Ear Hospital after directly viewing the Sun during the transit of Venus on June 6, 2012, or the partial eclipse of the Sun on November 14, 2012, were examined. All patients underwent visual acuity testing, dilated fundus examination, and SD-OCT imaging (Heidelberg Engineering, Heidelberg, Germany) both on presentation and at 3 or 5 months’ follow-up. Specific

Results

Patient 1 was a 10-year-old boy who gazed at the sun with both eyes through binoculars during the partial eclipse of the Sun. On initial examination, his best-corrected visual acuity was 20/20 in the right eye and 20/40 in the left eye. There was yellow pigmentation at the fovea in both eyes. The initial SD-OCT (Figure 1A) in the right eye showed disruption at the foveal photoreceptor ellipsoid zone (previously referred to as the inner segment–outer segment line2) as well as changes at the

Discussion

Despite wide knowledge that staring at the Sun endangers vision,3 the practice continues to occur. Generally, the initial loss of vision is mild or moderate and rarely severe.4 Solar retinopathy in children may cause persistent damage to multiple retinal layers predominantly via photochemical mechanisms. It is thought that photoreceptor destruction may follow from initial photic damage to the retinal pigment epithelium (RPE).

In our patients, visual acuity in the affected eyes ranged from 20/20

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This study was conducted at the Royal Victorian Eye and Ear Hospital, Australia.

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