Abstract
PURPOSE: Subretinal fibrosis has been reported as a presumed late sequela of orbital trauma in those with Stargardt disease (STGD). This case report highlights the sequential pathologic changes in response to trauma utilizing multimodal imaging. OBSERVATIONS: An asymptomatic 19-year-old female with no significant ocular history presented for possible drusen. Initial imaging noted yellow-white pisciform perifoveal flecks in both eyes with corresponding hyper-and hypo-fluorescent lesions on fundus autofluorescence and hyperreflective deposits on near-infrared and spectral-domain optical coherence tomography (SD-OCT). A few months later, the patient presented with a new onset "black shadow" in the right eye after a traumatic periorbital injury, with multi-modal imaging revealing sequelae of commotio retinae superotemporally. Follow-up imaging three months later revealed a large patch of hyperpigmented chorioretinal scar corresponding to the region of commotio. SD-OCT delineated findings consistent with subretinal fibrosis. Given the constellation of findings and subsequent genetic testing, the patient was diagnosed with STGD. CONCLUSIONS AND IMPORTANCE: Multimodal imaging allows for the detection of traumatic transformation of STGD and monitoring for early signs of massive lipofuscin release within the immediate post-traumatic period. Given the impact of minor orbital trauma on prognosis, caution should be taken to minimize and prevent orbital trauma in patients with STGD.