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JAMA Ophthalmology Clinical Challenge
October 2014

Bilateral Neuroretinitis and Retinal Hemorrhages in an Immunocompetent Patient

Author Affiliations
  • 1Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2014;132(10):1243-1244. doi:10.1001/jamaophthalmol.2014.3341

A previously healthy woman in her early 20s presented with bilateral decreased vision of 2 weeks’ duration in the left eye and 5 days’ duration in the right eye. She denied any medication use and had no history of ocular surgery or known ophthalmic disorders. Best-corrected visual acuity was counting fingers at 1 ft OD and 20/300 OS. There was no afferent pupillary defect. Slitlamp examination revealed fine keratic precipitates bilaterally, with 2+ anterior chamber cells in her right eye and 0.5+ cells in her left eye. Dilated fundus examination of the right eye demonstrated a creamy white lesion emanating superiorly from the optic nerve associated with areas of intraretinal hemorrhage and extensive perivascular sheathing along the vascular arcades into the midperiphery (Figure 1A). Ophthalmoscopic examination of the left eye showed a peripapillary preretinal gliotic lesion exerting mild traction on the macula with fine retinal striae and a macular star configuration of exudates (Figure 1B). Spectral-domain optical coherence tomography revealed significant cystoid macular edema with associated subretinal fluid in the right eye and hard exudates without evidence of cystoid macular edema in the left eye.

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