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JAMA Ophthalmology Clinical Challenge
August 2015

Bilateral Acute-Onset Vision Loss in a Previously Healthy Man

Author Affiliations
  • 1Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
  • 2Mid Atlantic Retina, Philadelphia, Pennsylvania
JAMA Ophthalmol. 2015;133(8):957-958. doi:10.1001/jamaophthalmol.2015.1139

A 40-year-old previously healthy man was seen with acute-onset bilateral decreased vision and metamorphopsia of 1-day duration. The patient denied any recent illness, travel, viral prodromal symptoms, headache, or skin lesions. He reported no exposure to pets or animals. A complete review of systems was otherwise negative.

At presentation, his visual acuity was counting fingers OD at 1 ft and 20/100 OS, without an afferent papillary defect. Slitlamp examination revealed fine inferior keratic precipitates bilaterally, with 3+ anterior chamber cells in the right eye and 2+ anterior chamber cells in the left eye. Dilated ophthalmoscopic examination demonstrated numerous confluent creamy yellow lesions in the peripheral retina, with more discrete nummular lesions in the posterior pole in both eyes (Figure 1A). No pigmented lesions were noted in the peripheral retina. In addition, fine macular striae were present in both eyes, along with subtle optic nerve edema (Figure 1B).