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

Abstract

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. A patient with binocular solar maculopathy presented with asymmetric ophthalmic manifestations and changes over 14 months of observation. Early recognition of solar maculopathy can be vital for early diagnosis and better prognosis. A 21-year-old male 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 (BCVA) declined to 20/50 in both eyes. He was right-eye dominant according to the hole-in-the-card test. The fundoscopy found a yellow spot in the center of both maculae. Spectral domain optical coherence tomography (SD-OCT) 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 above supported the diagnosis of solar maculopathy. SD-OCT images during follow-up indicated a diminishing disruption of the ellipsoid portion of the inner segments and RPE without treatment. Interestingly, the non-dominant left eye made a better anatomical recovery. Finally, the Snellen BCVA remained 20/20 in both eyes after 14 months. Binocular solar maculopathy can present asymmetrically and recover asymmetrically as well. The dominant eye suffered more obvious damage and poorer anatomical recovery than the non-dominant eye.