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Delayed Onset of Intraretinal Cystoid Abnormalities in Lightning Retinopathy

Tin Yan Alvin Liu, MD1; Craig See, MD1; Eric Singman, MD, PhD1; Ian C. Han, MD1
[+] Author Affiliations
1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
JAMA Ophthalmol. 2016;134(7):840-842. doi:10.1001/jamaophthalmol.2016.1018.
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This case report describes acute vision loss from a lightning strike with delayed onset of cystoid macular abnormalities.

Lightning-induced ocular injuries can involve any part of the eye. Reported macular pathology includes cystoid macular abnormalities, full-thickness macular hole, and pigmentary changes.1 Optical coherence tomography (OCT) is helpful to evaluate intraretinal cystoid abnormalities, which may resemble a macular hole on clinical appearance.24 We report a case of acute vision loss from a lightning strike with delayed onset of cystoid macular abnormalities.

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Figure.
Spectral-Domain Optical Coherence Tomography, Right Eye, Showing Evolution of Structural Abnormalities Over Time

A, Four days after lightning strike injury. Thickness map and registered line scan through fovea shows preserved foveal contour. B, Two weeks after lightning strike injury. Interval development of intraretinal cystoid abnormalities. C, Seven weeks after lightning strike injury. Improved intraretinal cysts with subfoveal outer retinal hyporeflective space. D, Four months after lightning strike injury. Subfoveal inner retinal hyporeflective space with restoration of outer retinal structures.

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