This 30YO male presented two hours following a paddleball injury to his right eye. Vision had decreased from a baseline of 20/20 to 20/80 at presentation.
Color photography shows a large area of temporal and inferotemporal outer retinal whitening, along with a smaller area of temporal macula commotio.
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.
