This healthy 10YO boy presented several hours after being hit in his left eye with a Nerf ball. Vision was 20/25.
Optos color RGB imaging shows subretinal whitening with associated retinal hemorrhages in the inferotemporal periphery. Optos Silverstone swept-source OCT shows at least two outer retinal hyperreflective bands in the uninvolved retina, which merge into a single hyperreflective band within the commotio. The retina was attached without breaks.
Observation was recommended, and the retinal findings normalized within several weeks.
Learning Points:
Commotio retinae is caused by direct, blunt eye trauma. The outer retinal whitening is due to shearing of the photoreceptor outer segments.
The term “Berlin’s edema” is a misnomer and should not be used, since the retina is not edematous. The acute white retinal changes usually resolve within several weeks. With resolution, the fundus appearance can normalize.
With more severe injury, outer retinal loss can allow RPE cells to migrate into the retina, giving a pseudo-retinitis pigmentosa appearance. Patients can also develop retinal breaks and detachment.
