Two days after blunt trauma from a cricket ball, a 19-year-old has reduced central vision but a clear media. Fundus examination shows grey-white opacification of the outer retina at the posterior pole with sparing of the foveal centre, giving a cherry-red spot appearance. The most likely diagnosis is:

• A Central retinal artery occlusion
• B Purtscher retinopathy
• C Valsalva retinopathy
• D Commotio retinae (Berlin oedema) ✓

Explanation

Commotio retinae results from blunt trauma disrupting the outer retinal layers and photoreceptor outer segments, producing transient grey-white sheening that spares the fovea. It usually resolves over weeks, though severe cases may leave pigmentary change. Central retinal artery occlusion shows diffuse retinal whitening with a true cherry-red spot and permanent vision loss. Valsalva retinopathy shows premacular haemorrhage, and Purtscher retinopathy shows multiple cotton-wool spots and haemorrhages after head or chest compression.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.