This 13YO boy presented 2 days following a slingshot injury to his right eye. Vision was counting fingers.
Color photography shows an opaque white discoloration below the retina throughout the posterior pole. Diffuse faint commotio retinae is also noted in the superior retinal periphery. There is a large choroidal rupture inferior to the macula, along with an inner retinal hemorrhage inferonasal to the nerve. OCT scanning shows variably opaque central subretinal fluid and marked cystic edema and disorganization of the nasal outer retinal layers external to the outer plexiform layer. Unfortunately, he was immediately lost to follow-up.
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, as the retina is not edematous. Our patient’s fluid is likely due to a contusive RPE injury that disrupted the outer blood-retinal barrier, allowing fluid to accumulate in the subretinal space and outer retina (Mishra et al, Journal of Vitreoretinal Diseases 2021;5:165-169).
