The human fovea after sungazing

Three patients who had malignant melanomas of the uvea and normal foveas agreed to look at the sun for one hour before enucleation of the eyes. Two of the patients sungazed with an undilated pupil, and 24 hours later, recovered their preexposure visual acuity with no detectable scotoma. One of the patients looked at the sun with a partially dilated pupil, and 24 hours later her visual acuity dropped from 20/20 to 20/25. After sungazing, all three eyes exhibited a prolonged recovery time from the photostress test. Fluorescein angiography in two patients showed that there was leakage of dye in the fovea. Fluorescein angiography done two days earlier had revealed no abnormalities. The foveas of all patients were studied by light and electron microscopy. Two patients showed sloughing of necrotic RPE into the subretinal space at the fovea. Degenerative changes and loss of melanin granules were observed in the RPE in the fovea of the third patient. This study shows that in spite of the minimal subjective visual impairment, leakage of fluorescein from the choroidal vasculature and histologic changes in the fovea could be demonstrated after exposure to the sunlight.