Flash photography-induced maculopathy

Abstract

Objective: To report a flash photography-induced maculopathy.

Methods: A professional photographer blinded himself accidentally and he consulted 3 days after the event with a scotoma in his dominant left eye. A unilateral acute light-induced maculopathy with hemorrhage was observed. The lesion was studied with colour photography, fluorescein and indocyanin angiography, autofluorescence imaging and repeated optical coherence tomography (OCT) imaging.

Results: At age 43, this professional photographer was blinded by the flash light of his camera and subsequently realized he had a scotoma in his dominant eye. Three days after the event visual acuity (VA) was 20/70 and an acute light-induced maculopathy was noted. Another three days later, VA was 20/50 and the lesions were less prominent. After one month, the photographer still had problems making sharp pictures, VA was 20/25 and a macular scar was observed. During further follow-up, he regained full vision and experienced no professional problems.

Conclusions: This case illustrates that the light of flash photography can accidentally hit an eye and induce a light-induced maculopathy.

Keywords: acute light-induced maculopathy; flash photography; foveal atrophy; hemorrhage; professional photographer.

Figure 1. Three days after the event, the left fovea is abnormal with yellowish swelling and a supramacular hemorrhage (top right). The early fluorescein angiogram shows normal perfusion and no window defects (top right). Midphase (bottom left) and late angiogram (bottom right) show no leakage and are normal.

Figure 2. OCT imaging with horizontal section of the left macula 3 days (top) and 6 days (bottom) after the event. Note the hyperreflective foveal lesion, initially prominent, and reduced 3 days later with at that time also regression of the hemorrhage to half size.

Figure 3. Six days after the event the ICG angiogram shows in the early phase (top right) focal choroidal non perfusion in the papillomacular and macular area, compatible with delayed filling in a watershed zone. In midphase and late phase ICG angiogram (bottom left and right) no anomalies are noted.

Figure 4. Four weeks after the event the left macula shows pigmentary changes, and is definitely different from the normal right macula.

Figure 5. The OCT imaging with a horizontal section of the macula is normal in the right eye and shows in the left eye a small deep foveal lesion. Moreover, the central macular thickness is mildly reduced in the left eye (245 micron RE, 236 micron LE).

Figure 6. The autofluorescence imaging shows in the right eye a normal hypofluorescent macula compatible with normal macular pigment and normal subfoveal RPE. The left macula is different with less hypofluorescent compatible with loss of macular pigment and/or RPE damage.