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JAMA Ophthalmology Clinical Challenge
December 2013

Smudge in My Vision

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago
JAMA Ophthalmol. 2013;131(12):1637-1638. doi:10.1001/jamaophthalmol.2013.7410

A 49-year-old woman noticed a “smudge” in the central vision of her right eye with associated photopsias. On examination, visual acuity measured 20/50 OD. Her local ophthalmologist considered a white dot syndrome and recommended a systemic workup. Results of a complete blood cell count, comprehensive metabolic panel, antinuclear antibodies (including DNA and ribosomal SSA/Ro), positron emission tomography and magnetic resonance imaging (MRI) of the brain, mammography, and chest radiography were normal. Dermatologic examination revealed a nevus on the left arm, a nevus on her left shoulder, and seborrheic keratosis on her left shoulder. Three months later, at the Illinois Eye and Ear Infirmary, she reported an improvement in her vision but noted negative images of dots when her right eye was closed. Review of systems was negative. Visual acuities measured 20/30 OD and 20/20 OS. Slitlamp examination findings were normal; there were no anterior chamber or vitreous cells. Funduscopic examination revealed yellow-white, multisized, subretinal, creamy lesions clumped in various portions of her retina, including the periphery (Figure 1). The lesions were smaller in the posterior pole and larger in the periphery. Subretinal serous fluid was present overlying some of the prominent lesions inferiorly, without associated exudate or hemorrhage.

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