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JAMA Ophthalmology Clinical Challenge
March 21, 2019

Cystoid Macular Edema With Scattered Intraretinal Hemorrhages in a Persistently Red Eye

Author Affiliations
  • 1Department of Ophthalmology, Duke University, Durham, North Carolina
  • 2Division of Vitreoretinal Surgery, Department of Ophthalmology, Duke University, Durham, North Carolina
  • 3Division of Neuro-ophthalmology, Department of Ophthalmology, Duke University, Durham, North Carolina
JAMA Ophthalmol. 2019;137(6):712-713. doi:10.1001/jamaophthalmol.2019.0069

A woman in her early 70s with a history of hypertension, Cushing disease status post–pituitary radiotherapy (1973), left sphenoid wing meningioma involving the left optic nerve and cavernous sinus status postsurgical debulking (2009), radiotherapy with concurrent temozolomide followed by intravenous bevacizumab, and a single prior episode of deep venous thrombosis presented with 2 months of eye redness and decreased vision in her right eye. She previously received a diagnosis of viral conjunctivitis at an outside institution and was treated with topical prednisolone acetate without improvement before presenting to our institution. On examination, visual acuity was 20/25 OD and hand motions OS. A relative afferent pupillary defect was present on the left in the setting of left optic atrophy from the patient’s locally invasive meningioma. Confrontational visual fields were otherwise full in the right eye. Intraocular pressures were within normal limits in both eyes. Hertel exophthalmometry was notable for 3 mm of proptosis on the right. Slitlamp examination demonstrated 3 to 4+ meibomian gland dysfunction in both eyes, but with prominent conjunctival injection in the right eye only. Dilated funduscopy revealed scattered intraretinal hemorrhages (IRHs) and cystoid macular edema (CME) in the right eye, which was also seen on optical coherence tomography (Figure 1). Vital signs, complete blood cell count, and the results of thyroid function tests were within reference ranges. Magnetic resonance imaging and magnetic resonance angiography of the brain and orbits with and without contrast showed a stable size of the meningioma and were otherwise normal.

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