A Case of Bilateral Macular Phototoxicity and the Role of Multimodal Imaging

Macular phototoxicity is a rare form of retinal injury caused by intense light exposure, most commonly from direct sun-gazing or viewing a solar eclipse without adequate eye protection. We report a case of bilateral macular phototoxicity in a 35-year-old female photographer with no significant past medical history, who developed acute central vision loss after approximately one hour of inadvertent sun exposure. She presented 48 hours after the incident with markedly reduced central vision (only light perception centrally) in both eyes, while peripheral vision remained intact. Dilated fundus examination revealed bilateral circumscribed focal foveal hypopigmentation in the absence of other retinal or optic nerve findings. Optical coherence tomography (OCT) scans confirmed foveal phototoxic damage, showing a normal overall contour but with juxtafoveal microcystic changes and hyperreflective lesions at the fovea in both eyes, consistent with acute macular phototoxicity. Conservative management with lubricating eye drops and oral nutritional supplements was implemented. Over the ensuing weeks, her visual acuity improved from an initial profound central scotoma to 20/40 in both eyes at 10 days, and 20/40 (left eye) and 20/30 (right eye) by one month post-exposure. Follow-up OCT demonstrated resolution of macular swelling and reconstitution of retinal layers. By five months, her visual acuity had fully recovered to baseline (20/20); however, a small persistent central scotoma remained in the left eye. This case illustrates the clinical course of macular phototoxicity and highlights the importance of patient education on ocular sun safety. Early recognition is important, as most cases show significant spontaneous recovery, but preventative measures are paramount since treatment options are limited.