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JAMA Ophthalmology Clinical Challenge
January 2015

A Painful Red Eye

Author Affiliations
  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
JAMA Ophthalmol. 2015;133(1):95-96. doi:10.1001/jamaophthalmol.2014.3888

A man in his 40s with a history of sinusitis presented with a 2-month history of worsening pain and redness of the right eye and nasal congestion. He was previously diagnosed with conjunctivitis and treated empirically with artificial tears, ofloxacin drops (0.3%), and prednisolone acetate drops (1%) 4 times a day, without improvement.

His visual acuity was 20/20 OD. Examination findings of the anterior segment of the right eye revealed a raised, nonmobile, engorged perilimbal nodule in the inferotemporal sclera that was tender to palpation and did not blanch with phenylephrine drops (2.5%) (Figure, A). The ultrasonogram demonstrated a noncystic, regular, dome-shaped lesion with medium to high reflectivity localized to the sclera without intraocular involvement (Figure, B). The remaining results of the right-eye examination and the entire left-eye examination were within the reference range. In addition, the patient had a right-sided intranasal mass.

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