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JAMA Ophthalmology Clinical Challenge
May 2018

Progressive Bilateral Scleral Pigmentation in a Patient With Ocular Hypertension

Author Affiliations
  • 1Medical student, University of Illinois College of Medicine, Chicago, Illinois
  • 2Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Illinois
JAMA Ophthalmol. 2018;136(5):587-588. doi:10.1001/jamaophthalmol.2017.5148

A white woman in her mid-60s presented with progressive bilateral scleral pigmentation (Figure 1A). Her ocular history included narrow angles and ocular hypertension that were managed with laser peripheral iridotomy and topical antiglaucomatous medications in both eyes. On examination, her visual acuity was 20/25 OD and 20/20 OS, with intraocular pressure of 21 mm Hg OD and 21 mm Hg OS. Slitlamp examination demonstrated mild cataract with narrow angles, with patent laser peripheral iridotomy in each eye. Ophthalmoscopic examination demonstrated peripheral paving-stone degeneration in the right eye and peripheral retinal pigmentary abnormalities in both eyes. During subsequent visits to the clinic, pigmentation was also noted in the auricles of both ears (Figure 1B).

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