This healthy 10YO boy presented with a 5-year history of blindness in his right eye. His mother said that he injured his eye after falling while playing at school.
Color imaging of his right eye shows a white nerve and retinal vessels, a variably pigmented macular scar, and a moth-eaten appearance to the RPE outside the macula. The left eye was normal.
Learning Points:
The differential diagnosis for unilateral optic nerve atrophy, chorioretinal scarring, and narrowing/sclerosis of the major retinal vessels is relatively small.
The term ‘unilateral wipe-out syndrome’ was coined by Dr. Gass (Ophthalmology 1978;85:521-545) in describing end-stage diffuse unilateral subacute neuroretinitis (DUSN).
Other causes include trauma, ophthalmic artery occlusion, and post-inflammatory (i.e., acute retinal necrosis syndrome, ARNS). Despite the history, it is hard to imagine how a 5-year-old child falling at a playground could cause this type of injury.
