Shortly after people throughout the United States had an opportunity to witness a total solar eclipse, primary care providers began hearing from patients who had viewed the eclipse without protective equipment and now have concerns about their vision.
Case study: You walk into the clinic the morning after a total solar eclipse passes through your state. Your nurse looks frazzled. He tells you that you have a waiting room full of add-on patients complaining of eye problems after they directly looked at the eclipse yesterday afternoon. You tell him to lead them into exam rooms, and you will start with a long-time patient of yours named Dave. Dave is an obese 70-year-old man with a past medical history of hypertension and elevated cholesterol. He presents to the clinic today because he watched the eclipse yesterday without wearing eye protection. An hour afterwards, he began having vision changes and is now panicked that he is going blind. What do you ask Dave?
You ask him to tell you additional information about his symptoms. He tells you that he watched the eclipse with his right eye, and he is now experiencing blurry vision with a blind spot in the middle of his field of vision in that eye. Not surprisingly, he denies any eye pain or changes in vision in his left eye. On physical exam, he does not have any redness, tearing, or discharge from either eye. He also has full range of motion in his eyes and no evidence of nystagmus.
You suspect that Dave has acute eclipse retinopathy. Acute eclipse retinopathy is a well-known eye disease that captures the attention of the medical establishment every few years after an eclipse. Eclipse retinopathy is caused by damage to photoreceptors and the retinal pigment epithelium cells of the macula. The signs and symptoms include blurry vision, wavy lines, blind spots, and other changes in visual perception. Symptoms begin one to four hours after exposure, and pain is not a symptom of eclipse retinopathy. What do you do next?
You decide to refer the patient to an ophthalmologist for further work-up. Work-up may include a slit lamp fundus examination, fluorescein angiography, and/or optical coherence tomography (OCT) investigation of the macula. Luckily, Dave is able to get an appointment within an hour. Later that afternoon, the ophthalmologist sends you an update. She discovered a small yellow spot surrounded by a gray ring in the fovea on fundus examination, suggesting damage from the eclipse. The ophthalmologist would like to follow up with Dave at regular intervals. Luckily for Dave, many of these cases of mild eclipse retinopathy at least partially resolve. How do you plan for the next eclipse?
You recommend that all your patients wear eye protection while watching the eclipse – even if they will only watch the eclipse for a few seconds with one eye. In the meantime, patients who have been diagnosed with eclipse retinopathy should be followed by an ophthalmologist until their symptoms stabilize or resolve.
Have you seen any recent patients with acute eclipse retinopathy? Share your experiences in the comment section below.
Khatib N, Knyazer B, Lifshitz T, Levy J. Acute eclipse retinopathy: a small case series. J Optom. 2014;7(4):225-8.
Photo Credit: © 2017 Richard Ball
Dr. V. Silverstein
Published on 9/1/17