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JAMA Ophthalmology Clinical Challenge
December 6, 2018

A Woman With Fluctuating Left Eye Swelling and Redness

Author Affiliations
  • 1Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
  • 2Section of Neuroradiology, Department of Radiology, University of Chicago, Chicago, Illinois
JAMA Ophthalmol. Published online December 6, 2018. doi:10.1001/jamaophthalmol.2018.4269

A 63-year-old healthy woman presented with a 3-week history of fluctuating left eye swelling and redness. She also reported a 1-week history of left eye discomfort and left-sided tinnitus and a 1-day history of binocular horizontal diplopia. She denied any history of recent trauma. Ophthalmologic examination at the time revealed visual acuities of 20/30 OD and 20/40 OS. Intraocular pressures were 15 mm Hg OD and 21 mm Hg OS, with a widened pulse pressure of the left eye. Extraocular motility revealed a left eye abduction deficit. Pupils and confrontational visual fields were unremarkable. Hertel measured 16 mm and 17 mm, respectively. Slitlamp examination of the right eye was unremarkable, but examination of the left eye revealed a large subconjunctival hemorrhage and engorged episcleral veins (Figure 1). Fundus examination of both eyes was unremarkable.

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