This healthy 19YO male was hit in his right eye while playing soccer one day earlier. Vision was 20/20.
Optos color RGB imaging shows subretinal whitening with associated retinal hemorrhages in the superotemporal 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. The retinal appearance and OCT completely normalized 1 month later (not shown).
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. 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.
