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JAMA Ophthalmology Clinical Challenge
December 2018

A Flushed Face and Dilated Retinal Veins

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor
  • 2Department of Ophthalmology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
  • 3Department of Pathology, University of Michigan, Ann Arbor
  • 4Comprehensive Cancer Center, University of Michigan, Ann Arbor
  • 5Division of Ophthalmology, Surgical Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
JAMA Ophthalmol. 2018;136(12):1414-1415. doi:10.1001/jamaophthalmol.2018.3300

A man in his 70s presented for a routine follow-up appointment. He denied any visual or systemic symptoms, and his medical history was significant for hypertension and atrial fibrillation treated with cardiac catheterization and ablation. Medications included amlodipine besylate, 5 mg daily, and aspirin, 81 mg daily. His family and social history were unremarkable. On examination, his visual acuity was 20/20 OU. The intraocular pressure in both eyes was normal, and there was no relative afferent pupillary defect. Extraocular motility and confrontational visual fields were also normal. On physical examination, facial plethora was evident (Figure 1A). Retinal examination of the left eye revealed 2 blot hemorrhages and dilatation of the retinal veins (Figure 1B). Retinal examination of the right eye also revealed dilatation of the retinal veins. These abnormal findings were not present 1 year earlier. Fluorescein angiography revealed a prolonged arm-to-retina transit time of 22.6 seconds (normal, 10-16 seconds). Optical coherence tomography scans of the macula in both eyes were normal. In addition, an area of bruising was noted on the right shoulder in the absence of any history of trauma to the shoulder.

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