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JAMA Ophthalmology Clinical Challenge
February 2, 2017

Bilateral Retinal Hemorrhages in a Young Man

Author Affiliations
  • 1Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
JAMA Ophthalmol. Published online February 2, 2017. doi:10.1001/jamaophthalmol.2016.3867

A man in his 30s was referred to the retina clinic with a diagnosis of bilateral branch retinal vein occlusions. He reported flashes and progressive blurry vision in both eyes over a period of 6 days. He had no history of eye problems. His medical history was negative for diabetes and hypertension, and review of systems was positive for recent easy bruising and progressive fatigue.

His initial best-corrected visual acuity was 20/25 OD and 20/50 OS. Results from examination of his pupils, motility, intraocular pressures, confrontational visual fields, and anterior segments were normal. A dilated fundus examination was conducted (Figure). He had bilateral flame-shaped and intraretinal hemorrhages in both maculae along the superior arcades and some scattered peripheral hemorrhages. There was no vessel tortuosity, and there were hard exudates in the left macula. Spectral-domain optical coherence tomography showed areas of hyperreflectivity in the middle and outer retina. Fluorescein angiography of both eyes showed blocking in the areas of hemorrhage, good venous filling, no leakage, and no neovascularization.

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