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.
Boston Eye Blink 
I have had this hazy blue spot for 6mo. Retinal specialists did not find much definitive except one noted small fatty deposits.
I also see my retinal blood vesssels when I open my eyes and some faint obscurity as if looking through bathroom glass
StarGardts sounds similar to what I’m experiencing but it’s in one not both eyes and I’m 69
I’d come see u but I’m near San Francisco
I’m wondering if it’s small screen related
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Hi Frances, thank you for your interest in this case. It is hard to say what is causing your symptoms without actually examining your eyes. A retinal specialist would be an appropriate expert to diagnose the condition if the cause is from the retina. If they cannot find any problem now, monitor your symptom and have regular eye exam will be the right thing to do. Good luck!
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I have a cataract on left eye which I have had for 15 years. I paid to have right eye Cataract removed ten years ago and opticians keep saying I meet the driving standard so don’t send me to have left one removed. I have started seeing a bluish or green circle in left vision difficulty to say if it is obscuring vision or is it the cataract. With both eyes open I don’t see it only when looking through left eye. Seeing a consultant next week.
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I had cataracts removed both eyes and Epiretinal membrane removed on same eye as had green spot
Spot faded to fainter gray but still there affecting facial recognition and needing brighter light than right eye.
Good luck with yours
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Hello,
I’m 21 and I have been experiencing a faint discoloration or persistent afterimage spot since October 14, 2023 (The Solar Eclipse Incident). On the first day, it was a really bright afterimage flash for about 11 hours, and I even rated it to myself as 10/10 for how intense that spot was. I didn’t stare at the sun for more than 10 or 15 seconds. Afterward, I visited an ophthalmologist to have my eyes scanned using Optical Coherence Tomography (OCT), and he confirmed there is no permanent damage to my retina. He did not mention palinopsia but noted it might fade away. Since then, I’ve been avoiding bright light sources and looking up information about eclipse/solar retinopathy, where I don’t have any blind spots, scotoma, or distortion.
(I wear glasses because I am farsighted, even before the incident, and my vision is still normal with temporary sharpness without using my glasses.) I’m trying to rest my eyes to reduce persistent afterimages, but they are still somewhat present. One thing I understand about these symptoms is that my photoreceptor cells are oversimulated or experiencing temporary fatigue. For example, staring at a color, like purple, may result in seeing a faint discoloration spot, such as light blueish or green, which then fades away. If I look away from that color, I might still see the previous color of the spot before it eventually disappears, creating a delayed effect. When I blink or barely close my eyes, I can barely see faint afterimages that fade away.
As of now, it feels like a 4 or 5/10 since the incident, and the spot is diminishing. It’s almost gone, appearing only occasionally when I see discoloration. Sometimes, I notice blue or purple dot flashes during activities for a split second. It has been 2 months since the incident, providing an update on my eye status. I still wish I had stayed inside during the solar eclipse to avoid these issues, but I feel like I have a second chance to recover my eyes but I’m genuinely feeling scared if my vision becoming worse or not. Wish me luck.
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Hi Dr Juan,
I reached out to you via LinkedIn regarding this blog post.
I’m having the exact same symptoms as your patient. Sudden onset of the greenish/blue spot in my vision in Nov. 2023. It hasn’t gotten much worse, some days I notice it more than others but typically this is due to anxiety.
I notice it mostly when looking at electronic screens or blinking quickly.
My imaging results look 1:1 of your patient. A slight “burn” on the retina with no cause.
Do you have an update on the patient or more information about what could have caused this? It’s causing me a lot of anxiety and it seems like no one is able to tell me what is causing it.
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Hi Hannah, sorry to hear your symptoms. I have lost that patient to follow up so not sure how she’s doing. There are a lot of things we don’t know about the retina and diseases that may affect it. I think that it’s possible it is something other than solar retinopathy. If I learn more about this condition, I will post an article. Anyone else having this condition please let me know as well
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I have this exact problem since november of last year it hasn’t gotten better or worse i notice it most when i go from closing my eyes to opening them or when i go from a dark room to a bright one it sometimes sparkles like i see multiple tiny black dots shimmering within the bluish green spot my eye doctor only found a freckle by my macula but i always worry if its something else as he said he doesn’t even know if thats why im seeing what im seeing
i dont believe he found a little lesion like the one in the photo or maybe he just didn’t check for one ? i did have a problem a few month prior with my eye i was seeing a black splotch and i had checked my eye with a flash light like full on flashed it in the side of my eye to where i could see my blood vessels
at the time i didn’t know that it was my blood vessels and it freaked me out so i did end up shining a bright flashlight in my right eye constantly maybe thats why i got the spot? im not sure but im thinking about going back to an eye doctor, has yours gone away or got worse?
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