Self-limiting Bilateral Foveal Detachment after Coup-Contrecoup Injury

A 68-year-old man had sudden, painless, bilateral central blurred vision after an automobile collision. He did not lose consciousness. Three hours later, visual acuity was 20/150 in his right eye and 20/300 in his left eye. OCT showed bilateral subfoveal and intraretinal fluid (Fig A). One day later, intraretinal fluid had resolved with residual subfoveal fluid (Fig B). The posterior hyaloid was broadly adherent, and the choriocapillaris appeared abnormally hyperreflective (Fig C). Two months later, the only OCT abnormality was irregularity of the ellipsoid zone (Fig D). Visual acuity recovered to 20/25 in both eyes. Acute, bilateral, self-limiting foveal detachment after coup-contrecoup injury, sometimes referred to as “whiplash maculopathy,” is a rare but likely under diagnosed condition. Possible mechanisms include broad vitreomacular traction, transient choriocapillaris ischemia, or hyperacute rise in endogenous corticosteroids leading to increased choroidal vascular permeability (Magnified version of Fig A-D is available online at www.aaojournal.org/). Figure thumbnail gr1

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