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JAMA Ophthalmology Clinical Challenge
August 30, 2018

Sudden-Onset Unilateral Macular Hemorrhage in a Middle-aged Man

Author Affiliations
  • 1Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
JAMA Ophthalmol. Published online August 30, 2018. doi:10.1001/jamaophthalmol.2018.1095

A white man in his early 50s presented to the emergency department of Massachusetts Eye and Ear with a 1-day history of sudden decreased visual acuity in the right eye. He denied any recent trauma, flashes, floaters, pain, or any prior similar episodes. His medical history was remarkable for asthma and prostate cancer, and review of systems was negative except for his visual loss.

On examination, his best-corrected visual acuity was 20/400 OD and 20/20 OS. Pupils were reactive with no relative afferent pupillary defect, and intraocular pressure measurements were unremarkable, as were results of the external and slitlamp examinations. Dilated fundus examination of the right eye showed submacular hemorrhage with pigment epithelial detachment (Figure 1A). Results of a dilated fundus examination of the left eye were unremarkable. Optical coherence tomography (OCT) of the right eye (Figure 1B) revealed subretinal and sub–retinal pigment epithelium (RPE) hemorrhage; results were unremarkable in the left eye.

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