Wednesday April 26, 2006
So, it was my first year of my ophthalmology residency and these three sisters came into the ER, all about 30-ish, all in a panic. Someone from their church told them that if they stared at the sun, they could see the Virgin Mary in its corona. So about 8 am that morning, one of the sisters decided to try it. She stared up at the sun and after several minutes or so (minutes! yikes!), she noticed a green halo around the sun. "Cool!" she thought, "I'm having a divine vision!" and although she was a bit dazzled she called one of the other two sisters to tell her and then that sister ran outside to look for herself.
...okay, here is some foreshadowing. That wasn't a divine vision, that was her retinal cells screaming in terror as they were getting burnt to a cinder... but more on this below...
When the first sister hung up, she blinked her eyes over and over, but then was shocked to see her child's face had disappeared.... instead of a face there was a big fleshy smear. She was hysterical when the three women came in (I think they got the third one to drive them over). The second sister, having peered at the sun for less than a minute, decided to look away, but by then noticed the center of her vision was blurry.
I felt terrible for these women, but I also wanted to just shake them and shriek, "What were you thinking!?"
"So, what happened?" I hear you asking. “And why is it so bad to look at the sun?”
You know that trick where you take a magnifying glass and use it to burn an ant by focusing the light of the sun on it? Remember that the energy in the light of the sun is so powerful that even though it is 93 million miles away, the sun heats our entire planet. So of course the sunlight fries the poor little ant (Case 1.)
Now, do you remember that there is also a lens in your eye that focuses images on your retina (the retina is the tissue that lines the inside of your eyeballs)? That lens in your eye that you are born with works exactly like a magnifying glass. Exactly the same (Case 2). That’s why you must never, ever stare at the sun. Yes, that's what these women had done. They'd burned a big hole in their retinas. And since they were staring right at the sun, they burned the hole right in the middle of their vision.
...and you say, "What was with the green halo then? The one she thought was a divine vision?"
Well, pain nerve cells in your skin tell your brain "PAIN!" and cold nerve cells in your skin tell your brain "COLD!" but inside your eye, the retinal nerve cells only can say "LIGHT!" and "COLOR!" and that is about it. So the burning of the retinal tissue led to the retina screaming out to the brain, but since retinal cells can't say "OMG! WTF! HELP! AHHHH!!!" they just said, "LIGHT!!!!" "COLOR!!!" Since the patient had no prior experience with retinal injury, she didn’t know how to interpret the green halo. So she just assumed it was something metaphysical. Actually, what she was seeing was likely was not a green halo, but a large green circle. She was likely also seeing that green glow in her center vision (rather than just a halo) but the intensity of the sun's light made the halo too weak to see centrally.
I honestly get the willies when I think about her retina being scorched.
But now I hear you asking, "Okay, but what was with the smeary faced kids?"
Well, despite what you see in movies, etc, when you lose a portion of your vision, you don't see a black spot, or a black area. Instead, your brain desperately tries to fill in the blank spot. So much so, that people who have strokes and lose, for instance, EVERYTHING to the right when they look ahead... will insist they see fine because their brain is filling in the missing stuff. Your peripheral vision is so crappy (try reading something off to the side when you are looking straight ahead) that the blurry image the brain fills in isn't perceptibly different from regular vision... well, except that it is total fantasy. Take a look at the examples below. In the bottom picture, do you see how the pedestrians and cars are completely gone? But the patient would think he is seeing okay, at least until the car he didn’t see coming hit him.
I had one stroke patient like that who insisted he was fine and continued to drive despite my proving to him that he couldn’t see to the side. He insisted he would just turn his head more when he drove. Oh man. I hated to take away his driving but I was sure he was going to run over a toddler. (I think I ended up getting his family to intercede when I suggested that they might get sued if he hit someone. Sigh.) As an ophthalmologist, I am probably one of the most defensive drivers on the road... I just assume everyone is just hallucinating away as they drive... that leads to a different subject (see The Grandma Who Saw Purple Gorillas).
Getting back to our three sisters, since this sister had burned her center vision, when she looked at her kid her brain filled in from the colors at the edges, namely flesh tone, and didn't do very well with the rest... hence...the smeary face.
Her vision went from 20/20 to 20/200 or so (the cutoff for legal blindness). The second sister, having a shorter exposure, also lost central vision but remained legally sighted.
LUCKILY, it was 8 am when they were doing their sun-gazing. If they'd been doing it at noon (when the sun's rays are most direct, and the least amount of dangerous blue wavelength light has been removed by atmosphere) they would have been MUCH worse off, and likely would have permanently blinded themselves, in much shorter time.
Anyway, the story has a somewhat good ending. First, it taught the women a lesson about believing everything they hear. (They assured me later they informed the congregation of the mistake.) But over the following YEAR (it took that long), the second sister got back most of her vision, and the first one did get some back... she was legal to drive at least (20/40) because with time she trained her eye to look with a slightly different bit of tissue. But she always had a fuzzy spot centrally, even three years later. What a nightmare.
Okay, so the take-home message here is:
DO NOT LOOK AT THE SUN!
...also, do not run with scissors.
This has been a public service announcement.
I presented these cases as a resident in 1998 and made the attached powerpoint presentation. The sun really hasn't changed much since then, so it is still might be useful to those of you interested.