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JAMA Ophthalmology Clinical Challenge
January 2016

Man With Blurry Vision and Eye Pain

Author Affiliations
  • 1Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2016;134(1):101-102. doi:10.1001/jamaophthalmol.2015.2131

A man in his 40s from India presented with a 2-month history of blurred vision and pain in the left eye. His medical history and findings from the physical examination were unremarkable. Findings from the examination of the right eye also were unremarkable. Best-corrected visual acuity was 20/20 OD and 20/60 OS. The left eye had a posterior vitreous detachment with 1+ vitreous haze and macular edema (ME). Most notably, there was extensive peripheral retinal hemorrhage with obliterative vasculitis extending from the arcades through the midperiphery (Figure 1A). Findings on fluorescein angiography were normal for the right eye and confirmed vascular staining, retinal ischemia, and hemorrhage in the left eye (Figure 1B). Optical coherence tomography demonstrated mild ME. The results of a subsequent autoimmune and inflammatory workup, including tests for antinuclear antibodies, anti–double-stranded DNA antibodies, antimyeloperoxidase antibodies, antiproteinase 3, angiotensin-converting enzyme, and lysozyme, were negative. The results of a workup for infectious diseases were negative for syphilis and Lyme disease but revealed a positive result on the QuantiFERON Gold test (QIAGEN). While the patient never developed symptoms suggestive of tuberculosis nor was he diagnosed with active tuberculosis, infectious disease consultants subsequently prescribed antituberculosis therapy. He was also treated with 60 mg of oral prednisone daily, but 1 month after presentation, his visual acuity declined to 20/100 OS owing to increased ME.

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