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JAMA Ophthalmology Clinical Challenge
January 30, 2020

Ocular Juvenile Xanthogranuloma in an Older Teenager

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
  • 2Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School, Houston, Texas
JAMA Ophthalmol. 2020;138(3):312-313. doi:10.1001/jamaophthalmol.2019.4982

A 19-year-old man presented with recurrent left eye redness and photophobia for the past year. The patient had previously been treated with topical corticosteroid therapy, which provided temporary relief of his symptoms. Visual acuity was 20/20 OU with normal intraocular pressures. The results from the slitlamp examination of the right eye were within normal limits (Figure 1A). Examination results of the left eye demonstrated 2+ diffuse conjunctival hyperemia, 1+ anterior chamber cell, and a vascularized iris infiltrate (Figure 1B). Results of the dilated fundus examination were within normal limits in both eyes. Ultrasound biomicroscopy of the left eye demonstrated areas of ciliary body thickening 360° and a thickened iris pupillary margin superiorly and nasally. A full review of systems was negative for other abnormalities including skin lesions. Test results for tuberculosis and syphilis were negative.

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    1 Comment for this article
    Ocular JXG
    Alfred Cossari, MD | Mather Hospital/Northwell Health
    I believe some ophthalmologists would have utilized an aggressive course of topical steroids before proceeding to a surgical biopsy. It does not appear that this treatment strategy would have had greater risk than a surgical procedure.