Last summer’s solar eclipse captivated millions of people—and harmed at least a few. Sustained viewing of the phenomenon without proper eye protection led to isolated reports of solar retinopathy. Symptoms are typically bilateral and characterized by blurred vision, various patterns of scotoma, chromatopsia, headache and photosensitivity.

A recent small case series reports the findings of an investigation into the condition in Utah following the August 21, 2017 eclipse.

Twenty-seven patients had presented to ophthalmology practices with concern for vision changes after the solar eclipse, and six had exam findings consistent with solar retinopathy. Of these six cases, charts were available for three. The common finding in all cases was a central scotoma with a correlating change to the inner segment/outer segment (IS/OS) junction on optical coherence tomography (OCT). Demographically, all three patients were young males.

Case 1: A 17-year-old male presented with bilateral central scotoma after direct visualization of the eclipse for 15 seconds three separate times. Visual acuity was 20/25 OU without correction. Funduscopic exam showed bilateral yellow foveal spots and OCT revealed bilateral subfoveal nodules suggestive of possible changes to the ellipsoid zone. At follow-up two months later, visual acuity was 20/25+2 OD and 20/20 OS and a small yellow spot persisted within the fovea of the left eye.

Case 2: After direct visualization of the eclipse for five to 10 seconds and use of solar eclipse viewing glasses for another 20 seconds, a 36-year-old-male experienced bilateral central scotoma. The patient demonstrated a visual acuity of 20/20+1 OD, and 20/15–3 OS. Fundus exam found small central foveal lesions and OCT showed abnormal (IS/OS junctions bilaterally as well as foveal outer retinal abnormalities consistent with solar maculopathy. He was lost to follow up.

Case 3: A 21-year-old-male, who stated that he directly visualized the eclipse for one second, presented with visual acuity of 20/50 OD and 20/20 OS. Retinal exam showed a red lesion in the macula surrounded by gray pigment OD and no positive findings OS. OCT showed a macular scar with disruption of rods and cones. FA was performed and showed window defects in the early and late macula. He also was lost to follow up.

“Changes in IS/OS junctions are typically caused by disruption of photoreceptor cells,” the authors wrote. “This corresponds well with data suggesting that electromagnetic radiation contributes to photoreceptor damage through inducing oxidative damage.”