Acute Retinal Concussion (Berlin's Edema): Sudden Blurred Vision and Visual Haze After Direct Ocular Trauma

Retinal edema and concussion of the fundus cells after severe trauma. Dr. Mahmoud Hassan explains the danger of neglecting retinal concussion and the importance of follow-up to rule out occult tears.

What is Acute Retinal Concussion (Berlin's Edema)?

Imagine your eye has suffered a strong blow, perhaps during an intense sport or a minor accident. You might not feel severe pain initially, but shortly after, your vision starts to blur, you feel a fog in front of your eye, or you might notice sudden haziness. These symptoms could indicate a condition known as acute retinal concussion, or medically referred to as Berlin's Edema.

Retinal concussion is a condition that occurs as a result of direct or indirect trauma to the eye, leading to hemorrhage or fluid leakage within the retinal layers, especially in the central area responsible for visual acuity (the macula). This leakage and hemorrhage hinder the function of the light-sensitive retinal cells, causing the annoying symptoms patients describe as sudden blurred vision and foggy eyesight.

Causes and Contributing Factors of Retinal Concussion

The primary cause of retinal concussion is a direct impact or strong trauma to the eye. These traumas can include:

• Sports Injuries: Such as football, basketball, boxing, or any sport involving physical contact or the potential for ball impact with the eye.
• Domestic or Traffic Accidents: Falls, collisions with objects, or accidental blows.
• Physical Assaults: Direct blows to the eye area or face.
• Concussion Brain Injury: In some cases, severe brain concussion can lead to eye injuries, including retinal concussion, due to violent shaking of the brain and eye.

It's important to note that the severity of the injury does not always correlate with the intensity of the impact. Sometimes, a seemingly minor blow can cause retinal concussion, while the eye might withstand stronger blows without significant effect. This depends on various factors such as the angle of impact, the location of the injury, and the pre-existing health condition of the retina.

Common Symptoms of Retinal Concussion

Symptoms of retinal concussion often appear shortly after the injury and may gradually develop over a few hours. The most prominent symptoms include:

• Sudden blurred vision: A feeling that vision has become unclear or hazy.
• Foggy vision: A sensation of a fog or film obstructing clear vision.
• Decreased visual acuity: Difficulty seeing fine details or recognizing faces.
• Color distortion: The patient may notice slight changes in color perception.
• Presence of spots or floaters: The existing floaters the patient sees may appear or increase in intensity.
• Light sensitivity: In some cases, the eye's sensitivity to bright light may increase.
• Mild pain or pressure sensation: The patient may feel some discomfort or pressure inside the eye.

It is crucial not to ignore these symptoms, even if they seem minor or temporary. Neglecting retinal concussion can lead to serious long-term complications.

Medical Diagnosis of Retinal Concussion

The diagnosis of retinal concussion primarily relies on a thorough eye examination by a specialized ophthalmologist. It begins with taking a detailed medical history about how the injury occurred and the symptoms the patient is experiencing. Subsequently, examinations are performed including:

• Visual acuity test: To assess the extent of vision impairment.
• Slit Lamp Examination: To examine the anterior and posterior parts of the eye and evaluate any external signs of injury.
• Fundus Examination: This is the most important examination, where the doctor dilates the pupil using special drops, then examines the retina and vitreous humor using an ophthalmoscope. In cases of retinal concussion, the doctor may notice leakage or hemorrhage in the macula area.
• Optical Coherence Tomography (OCT): This examination is an extremely important diagnostic tool, providing detailed cross-sectional images of the retinal layers, precisely revealing the presence of leakage or edema in the macula, and helping assess the severity of the injury.
• Fundus Fluorescein Angiography (FFA): May be used in some cases to assess blood flow in the retinal blood vessels and identify areas of leakage or occlusion.

Dr. Mahmoud Hassan, a vitreoretinal surgeon, emphasizes the importance of early and accurate diagnosis using the latest available technologies at Al Mashreq Eye Center, to ensure the best treatment outcomes.

Retinal Contusion Treatment and Follow-up

In most cases of acute retinal contusion, immediate surgical intervention is not required, as the body is often capable of gradually absorbing the exudate and accumulated blood. Treatment primarily focuses on:

• Rest and avoiding strain: The patient is advised to avoid strenuous physical activities and heavy lifting that may increase pressure on the eye.
• Medications: The doctor may prescribe anti-inflammatory medications or those that help reduce exudate.
• Regular follow-up: This is the most crucial part of treatment. The patient must adhere to follow-up appointments with the doctor for necessary examinations and to assess the retina's response to treatment.

In some cases where the exudate is severe or does not improve over time, the doctor may resort to other treatment options such as:

• Intravitreal injections: Using medications such as corticosteroids or anti-vascular endothelial growth factor (Anti-VEGF) agents like Eylea or Vabysmo, to help reduce exudate and inflammation. The cost of intravitreal injections (IVI) in Egypt for 2026 starts from approximately 7,000 EGP (estimated).
• Laser therapy: In rare cases, laser may be used to seal abnormal blood vessels if they develop.

Dangers of neglecting retinal contusion: Dr. Mahmoud Hassan emphasizes that neglecting to follow up on retinal contusion can lead to the development of serious complications, most notably retinal tears or detachment. Persistent exudate and pressure on the retinal layers can weaken them and cause cuts or tears, necessitating urgent surgical intervention. Therefore, meticulous follow-up after injury is essential to rule out any hidden cuts or undesirable developments.

Prevention and Management of Eye Injuries

Prevention is better than cure. It is advised to take necessary precautions to avoid eye injuries, especially during contact sports, by wearing appropriate protective eyewear. In the event of any direct impact to the eye, even if it seems minor, immediate consultation with a specialized ophthalmologist is crucial for the necessary examination.

If you experience blurry vision or fogginess after an eye injury, do not hesitate to seek specialized medical help. You can book an appointment at Al Mashreq Eye Center or contact us by phone.

For booking and inquiries: 01002310813

For more information and tips on eye health and retinal surgeries, you can follow Dr. Mahmoud Hassan's YouTube channel.

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