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Editor,—Individual cases of retinopathies after unprotected exposure to sunlight are frequently reported in patients with psychiatric disorders,1 after religious practices,2 3 or related to drug abuse.4Even though knowledge of the harmful effects of sun gazing dates back to ancient times5 there are still many reports on epidemics of patients with solar retinopathy after viewing solar eclipses.6 This case report demonstrates that, despite the availability of cheap and safe protection,7 cases of eclipse retinopathy are still observed and so strong preventive efforts should be made for future eclipses, especially for groups at risk.
An 11 year old girl was evaluated after complaining of bilateral central scotomata after observing the subtotal solar eclipse of 11 August 1999 in south eastern Switzerland without protective eyewear. Visual acuity 5 days after the event was 20/25 on both eyes. Amsler grid testing showed bilateral small central scotomata. Anterior segments were unremarkable. Biomicroscopy showed sickle form oedematous areas parafoveal in the deep retinal layers in both eyes, corresponding to the shape of the subtotal solar eclipse (Fig 1).
After 3 months the visual acuity was 25/20, the patient denied any residual scotoma in the Amsler grid testing. The retinal oedema had resolved, but there were some subtle pigmentary irregularities to be observed (Fig 2).
Areas of retinal oedema outlining a sickle—that is, the “brand” of the sun, have been described after the solar eclipses of 17 June 18908 and 29 April 1976.9 If the patient does not gaze at the sun for brief periods but observes it constantly for a longer period of time during a defined phase of the eclipse the subsequent retinal lesion can be sharply defined. From the shape of the “brand” one can determine the time phase of exposure, which in the present case was the maximum of the subtotal solar eclipse (Fig 1).
Approaching the 1999 solar eclipse there was extensive information in the media about appropriate eye protection and special glasses for eclipse viewing were widely available. In addition, there was cloudy weather over most parts of central Europe. Only a few mild cases of eclipse retinopathy have therefore been reported in the eastern part of Switzerland.
Our patient observed the eclipse from the mountains of south eastern Switzerland, where the sky was clear. Although the family was in possession of appropriate protective glasses, the 11 year old girl did not use them.
Although prevention strategies have proved to be very effective10 children seem to be the most at-risk group in the population for retinal damage from solar eclipses. We therefore recommend that special efforts be made to ensure eclipse viewing safety in children. The next total solar eclipse will take place over southern Africa and Madagascar on 21 June 2001.
We thank Mr Hugo Niederberger, ophthalmic photographer, for providing the pictures.
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