A previously healthy 17-year-old girl without a history of ophthalmological problems was admitted for management of systemic lupus erythematosus onset. She had mild anemia and a normal blood pressure level. While her visual acuity was not checked on admission, 1 week later, she complained of painless visual acuity loss in both eyes. Her visual acuity was 20/200 OD and hand motion OS. Her pupils were reactive to light, and the ocular motility and anterior segment were normal. A fundus examination revealed multiple nerve fiber–layer infarcts, intraretinal hemorrhages near the optic disc and throughout the posterior pole, and macular edema, with a prominent appearance of the macular xanthophyll greater in the right macula than in the left macula (Figure). Optical coherence tomography showed a central retinal thickness of 740 μm OD and 770 μm OS. Fluorescein angiogram showed no choroidal abnormalities. One month after starting corticosteroid treatment, her visual acuity was 20/80 OD and 20/200 OS.
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Fry MJ, Liberman P, Cartes C. Systemic Lupus Erythematosus in a Female Teenager. JAMA Ophthalmol. 2020;138(7):e194120. doi:10.1001/jamaophthalmol.2019.4120
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