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A 74-year-old woman was referred for bilateral blurry vision occurring 2 hours after a car crash. At the moment of impact, she was wearing her seat belt, the airbag deployed, and an intense flexion-extension head movement occurred.
Best-corrected visual acuity was 20/125 OD and 20/63 OS. Intraocular pressure was 19 mm Hg OD and 20 mm Hg OS. Slitlamp examination revealed no palpebral hematoma, and the anterior segment was found to be normal. On the fundus bilaterally, we only noted an alteration of the foveal reflection, with neither retinae commotio nor hemorrhages. Macular optical coherence tomography (OCT) showed bilateral macular edema with cystoid abnormalities (Figure 1). An epiretinal membrane also was noted in the left eye (Figure 1B).
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Whiplash is defined as a trauma caused by a mechanism of anteroposterior movement typically occurring during a car crash. Whiplash maculopathy was described in 1978,1 with all patients presenting with an immediate mild reduction in visual acuity after a car crash. Subsequent studies with OCT revealed bilateral macular thickening, with cystoid abnormalities located in the outer retina as well as preservation of the inner retinal layers.2 An apparent separation between the external plexiform and the external nuclear layers was noted.3
Other retinal traumatic damages affecting the posterior pole can occur after a car crash: a macular hole, a Purtscher retinopathy,4 or a retinae commotio. Retinae commotio is also called Berlin edema if the posterior pole is involved. However, the name might be confusing because there is no cystoid edema; rather, there is a hyperreflectivity located at the photoreceptor–retinal pigment epithelium complex.5 Whiplash maculopathy seems to result from a bilateral anteroposterior vitreomacular traction pulling on the fovea during a severe whiplash head trauma.6
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Corresponding Author: Frédéric Villard, MD, Department of Ophthalmology, University Hospitals of Geneva, Rue Alcide-Jentzer 22, Geneva 1205, Switzerland (firstname.lastname@example.org).
Published Online: July 25, 2019. doi:10.1001/jamaophthalmol.2019.2674
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank Marc-André Bagnoud, MD, Department of Ophthalmology, University Hospitals of Geneva, for referring a patient. He was not compensated. We also thank the patient for granting permission to publish this information.
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