The Hourglass Sign on Optical Coherence Tomography in Soccer-Related Blunt Ocular Trauma

Purpose: To describe the optical coherence tomography (OCT) findings in a series of patients following blunt trauma from a soccer ball. Methods : A retrospective case series was performed of 7 patients presenting with macular commotio. Results : Spectral-domain OCT demonstrated foveal hyperreflectivity with an hourglass configuration in all cases. Other OCT findings included irregularity of the outer retinal layers and angular sign of Henle fiber layer hyperreflectivity. These imaging findings resolved within 2 to 6 weeks. The mean final best-corrected visual acuity was 20/20. Conclusions : Blunt trauma from a soccer may produce a characteristic foveal pattern of hyperreflectivity, for which we propose the term “hourglass sign” in the setting of macular commotio. This configuration likely reflects the underlying anatomy of the foveal Müller cell cone and may represent a forme fruste macular hole without associated vitreomacular traction. The visual prognosis appears excellent.