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JAMA Ophthalmology Clinical Challenge
August 29, 2019

Uncovered Undulations

Author Affiliations
  • 1TOC Eye and Face, Austin, Texas
  • 2Austin Retina Associates, Austin, Texas
  • 3Dell Medical School, University of Texas at Austin, Austin
JAMA Ophthalmol. Published online August 29, 2019. doi:10.1001/jamaophthalmol.2019.3090

A 53-year-old man presented to his ophthalmologist for a newly noticed bulging left eye. He reported several eyeglass prescription changes in the left eye over the past 2 years and frequent ipsilateral tearing. He denied ocular discomfort, headaches, or double vision. He had a distant history of right temple melanoma that was excised with clean margins and accompanied by a negative sentinel lymph node biopsy result.

On examination, he was found to have a best-corrected visual acuity of 20/20 OD and 20/40 OS, with a normal pupillary response and intact color vision bilaterally. He had a mild limitation of left abduction and supraduction. He had 5 mm of relative left proptosis, with moderate resistance to retropulsion of the left globe. No change in globe position was appreciated with systolic pulsations or the Valsalva maneuver. Anterior segment examination results were normal bilaterally. Dilated fundus examination results of the left eye revealed an abnormality of the posterior pole (Figure 1A), which was confirmed on fluorescein angiography (Figure 1B).

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