Case Report: Asymmetric Changes of Ophthalmic Findings in Bilateral Solar Eclipse Maculopathy

Abstract

SIGNIFICANCE A more profound understanding of the relationship between ophthalmic findings and eye dominance is needed to guide the timely and proper treatment of binocular photic maculopathy or other macular degeneration. PURPOSE A patient with binocular solar maculopathy presented with asymmetric ophthalmic manifestations and changes during 14 months of observation. Early recognition of solar maculopathy can be vital for early diagnosis and better prognosis. CASE REPORT A 21-year-old man was reported to have blurred vision after staring directly at an annular solar eclipse several times for a few seconds on June 21, 2020. His Snellen best-corrected visual acuity declined to 20/50 in both eyes. He was right-eye dominant according to the hole-in-the-card test. The funduscopy found a yellow spot in the center of both maculae. Spectral-domain optical coherence tomography images revealed a full-thickness hyperreflectivity extending from the inner retinal layers to the retinal pigment epithelium (RPE) along with a localized disruption of the ellipsoid portion of the inner segments and RPE in both eyes. The medical history and clinical manifestations described previously supported the diagnosis of solar maculopathy. Spectral-domain optical coherence tomography images during follow-up indicated a diminishing disruption of the ellipsoid portion of the inner segments and RPE without treatment. Interestingly, the nondominant left eye made a better anatomical recovery. Finally, the Snellen best-corrected visual acuity remained 20/20 in both eyes after 14 months. CONCLUSIONS Binocular solar maculopathy can present asymmetrically and recover asymmetrically as well. The dominant eye suffered more obvious damage and poorer anatomical recovery than the nondominant eye.