By Juan Ding, OD, PhD
Case of the day series
A college student walked in for an urgent visit for seeing a bluish green spot in her right eye constantly for 1 week. She went to Colorado last week and did a lot of hiking, taking many photos everyday, enjoying nature. On the last day of the trip, she started seeing a bluish green spot in the right eye, more obvious in the bright background, but it’s there even after closing eyes. She was very scared and went to the local ER, where they did an ultrasound of the eye and found no retinal detachment, but did not know what’s wrong. After getting back to MA, she could not get an appointment with her regular eye doctor, and being the holiday season it’s busy everywhere. Fortunately her PCP at Umass directed her to our open access clinic.
Her vision is normal, 20/20 in each eye. Everything from the front to the back of both eyes are normal. I found no retinal detachment, not even vitreous floaters.
She asked, “Am I crazy? Am I imagining things?”
What do you do next?
Knowing too well that clinical exam has its limitations, I asked her to take an OCT photo. This is looking at the retina in cross sections, like virtually dissection the retina. There is a very small dot in the right eye, just temporal to the fovea, where the photoreceptor outer segment now shows a small defect (Figure 1). Amsler grid shows a matching scotoma nasal to the fixation.
Figure 1. OCT of macula cross section. Red arrow points to the lesion at the photoreceptor outer segment level (ellipsoid zone).
So I told her that she’s not crazy, a retinal lesion really exists to perfectly account for her seeing the spot.
But what caused it?
Solar retinopathy is the first thing that comes to mind. She denied looking directly at the sun. also denied exposure to laser including laser pen or in a science project. Then she mentioned that during daily hiking, she did spend a lot of time looking at camera screen which could be very bright due to reflecting sunlight. This seems to be the most plausible explanation for now.
I told her that solar retinopathy may get well on its own in weeks to months. It may also be irreversible. At any rate, there is no treatment for this. So we will monitor again in a few months.