43-year-old man was seen in the office on 8/24/2012. He was playing basketball last night. He was hit straight in the left eye with the ball. Initially he had darkness in his inferior vision and now he has darkness inferonasally in the left eye. He had some inflammation there and you suggested he take steroids and suggested he come here for an evaluation. VISUAL ACUITY: Vision OD is 20/16, vision OS is 20/32. IOP: OD 20, OS 15. The right eye has a pinguecula and the lens is clear. The left eye has a small subconjunctival hemorrhage nasally and a pinguecula. The lens is clear. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is . There is no posterior vitreous separation. The macula and periphery look healthy. OS: Vertical C/D ratio is . There is no posterior vitreous separation. There are trace vitreous cells. There is a patch of retinal whitening between 1:00 o’clock and 3:00 o’clock, extending a few disc diameters posterior to the equator. PHOTOGRAPHS: Photos show the retinal whitening. IMPRESSION: 1. COMMOTIO RETINAE – LEFT EYE DISCUSSION: I explained to the patient the left eye does have the equivalent of a retinal contusion and generally those are benign and are self limited. I suggested he return for check in two weeks, sooner should he notice an increased striking change.
The prognosis is excellent except in case of complications of choroidal rupture, hemorrhage or pigment epithelial damage, but damage to the macula will result in poorer recovery. The outcome can be worsened in the case of retinal detachment , atrophy or hyperplasia . Visual field defects can occur. In late cases cystoid macular edema sometimes develops which can further lead to macular destruction. Commotio retinae is usually self limiting and there is no treatment as such. It usually resolves in 3–4 weeks  without any complications and sequelae .