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JAMA Ophthalmology Clinical Challenge
July 2014

More Than Just Multiple Sclerosis

Author Affiliations
  • 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
  • 2Miami Veterans Affairs Medical Center, Miami, Florida
JAMA Ophthalmol. 2014;132(7):885-886. doi:10.1001/jamaophthalmol.2014.1407

A 51-year-old woman with a history of multiple sclerosis (MS) and 2 previous episodes of optic neuritis in both eyes presented with a 5-day history of photopsias and blurry vision in the left eye. The patient also noted decreased peripheral vision and pain on eye movements of the left eye. She described a recent episode of gastroenteritis prior to the onset of visual complaints. She was taking glatiramer acetate and tizanidine hydrochloride for MS. Her initial visual acuity was 20/50 in both eyes with a 1+ relative afferent pupillary defect in the right eye. The patient had red desaturation in the left eye, and her color vision, which was determined by use of an Ishihara test, was decreased in both eyes. Intraocular pressure and ocular motility were normal, and the results of an external examination, an anterior segment examination of both eyes, and a posterior segment examination of the right eye were unremarkable. A fundus examination of the left eye demonstrated grade 1 disc edema and multiple small to medium yellow-white deep retinal lesions throughout the macula and along the vascular arcades (Figure 1).

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