This 31YO male was referred for relatively asymptomatic central macular pigmentary changes. He gave a long history of twice-daily sun gazing, which always caused a very pleasurable sneezing episode. Vision was 20/30 OD and 20/40 OS.
Triton color imaging shows tiny foveal pigment loss. Swept-source OCT shows bilateral ellipsoid zone and outer segment defects.
We diagnosed him with the ACHOO reflex (Autosomal Dominant Compelling Helioophthalmic Outburst). And no, this isn’t an April Fools post, and we’re not talented enough to even make this stuff up if we wanted to! Patients with the ACHOO reflex sneeze when exposed to bright lights, typically sunlight.
We advised him to stop his sun gazing ritual, although we’re not sure this will be possible for him.
Learning Points:
The outer retinal damage in solar retinopathy is thought to be caused by photochemical outer retinal and RPE damage instead of a thermal burn. Vision is usually fairly good despite the outer retinal and RPE findings.
