Where is the main site of damage for Commotio Retinae?

• A. Superficial Capillary Plexus
• B. Between RPE and Photoreceptor Outer Segments
• C. Optic Nerve Head
• D. Between RPE and Choroid

Answer: (B)

Blunt trauma in commotio retinae primarily damages the outer retina, specifically the photoreceptor outer segments where they meet the retinal pigment epithelium. This interface between the photoreceptor outer segments and the RPE is where the mechanical shearing disrupts the photoreceptors, producing the characteristic transient whitening. The superficial capillary plexus is a vascular layer in the inner retina and is not the primary site of injury; the optic nerve head is a different structure affected in optic neuropathies; and the region between the RPE and choroid lies deeper than the outer retina and is not the typical locus of commotio retinae damage. Clinically, this injury can show up as outer retinal disruption on imaging (such as the ellipsoid zone on OCT) with variable recovery depending on the extent of the damage.