![]() OCT of the right eye was grossly unremarkable (Figure 2). The left eye also had a mild epiretinal membrane evident on OCT. OCT of the patient’s left eye revealed subfoveal photoreceptor inner and outer segment as well as ellipsoid zone disruption and mild mottling of the subfoveal retinal pigment epithelium (RPE). As such, OCT, fundus autofluorescence (FAF), fluorescein angiography (FA) and indocyanine green angiography (ICGA) were obtained for this patient. With the combination of this patient’s history, exam findings and fundoscopic appearance, multimodal chorioretinal imaging should be done to provide further insight into the diagnosis. Lastly, although low on the differential, primary and metastatic neoplastic etiologies should be considered. Infectious etiologies that must be considered in the setting of this patient’s fundoscopic appearance include syphilis, tuberculosis and diffuse unilateral subacute neuroretinitis. MCP/PIC and birdshot chorioretinopathy are less likely as they typically present bilaterally. APMPPE typically presents with larger, more confluent, plaque-like lesions. Included on the list of possible inflammatory etiologies are multiple evanescent white dot syndrome (MEWDS), acute retinal pigment epitheliitis, sarcoidosis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multifocal choroiditis and panuveitis/punctate inner choroidopathy (MCP/PIC), and birdshot chorioretinopathy. The differential diagnosis of unilateral yellowish-white deep retinal or choroidal lesions in the setting of photopsias and floaters includes inflammatory, infectious and neoplastic etiologies. PAGE BREAK Yellowish-white retinal lesions The vessels were of normal course and caliber without any sheathing (Figure 1). These spots were approximately one-eighth to one-quarter disc diameter, had mildly ill-defined margins and were more prevalent in the area of the superior arcade and just nasal to the optic nerve head. Left eye fundoscopy demonstrated trace vitreous cell, mild hyperemia of the optic nerve head with blunting of the disc margins, an orange-yellow foveal granularity and numerous deep retinal circular yellowish-white lesions distributed throughout the posterior pole but sparing the central fovea. Color fundus photography of the right eye and left eye.ĭilated fundoscopic exam revealed a normal fundus in the right eye. Anterior segment exam was unremarkable in each eye. Confrontation to visual fields was full in both eyes. Extraocular muscles were full and orthophoric in both eyes. IOPs were within normal limits in both eyes. She had a mild relative afferent pupillary defect in the left eye. On examination, the patient’s uncorrected visual acuity was 20/20 in the right eye and 20/70 in the left eye, which did not improve with pinhole. ![]() On review of systems, she denied shortness of breath, joint pain, rash, headache, oral or genital ulcers, recent upper respiratory symptoms or other viral illness. She was a non-smoker, denied intravenous drug use and was in a monogamous relationship with her boyfriend. Her ocular history was remarkable for one episode of unilateral iritis 3 years ago. ![]() She had a medical history significant for hypothyroidism managed with a low dose of levothyroxine. If you continue to have this issue please contact to HealioĪ 26-year-old Caucasian woman with a 3-day history of blurry vision, flashes of light and floaters in her left eye was referred by an outside comprehensive ophthalmologist for a retina evaluation. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |