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JAMA Ophthalmology Clinical Challenge
December 27, 2018

Blurred Vision and Wrinkled Retinas in an Elderly Man

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
JAMA Ophthalmol. Published online December 27, 2018. doi:10.1001/jamaophthalmol.2018.6254

A 64-year-old man presented to the emergency department with 2 months of progressively worsening vision in both eyes. The worsening vision was preceded by binocular diplopia, which was intermittent at first and then became constant. He had no relevant ocular or other medical history. A review of systems was notable for a 2-month history of progressively worsening shortness of breath. He denied any fevers, night sweats, or unintentional weight loss. Visual acuity was found to be 20/200 OD and 20/25 OS. His pupils were round and equally reactive, and there was no relative afferent pupillary defect. The intraocular pressure was normal in both eyes. On external examination, bilateral proptosis and increased resistance to retropulsion was observed. There was very limited extraocular motility in all directions of gaze on the right side and moderately limited extraocular motility on the left side. In addition, the patient had an esotropia and right hypertropia. Anterior segment examination revealed bilateral chemosis. The fundus examination (Figure 1) showed chorioretinal folds in both eyes and intraretinal hemorrhages in the right eye. The optic discs had normal color and sharp margins bilaterally.