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JAMA Ophthalmology Clinical Challenge
August 27, 2020

Atypical Case of Floaters in a Young Girl’s Eye

Author Affiliations
  • 1George Washington University Ophthalmology Residency Program, Washington, DC
  • 2Department of Ophthalmology, Children’s National Hospital, Washington, DC
JAMA Ophthalmol. 2020;138(10):1093-1094. doi:10.1001/jamaophthalmol.2020.1597

A 12-year-old girl with a history of myopia presented to the emergency department complaining of floaters in her right eye for the past 2 weeks. She had a medical history of patchy hair loss and a violaceous maculopapular rash on the face and upper extremities for 5 years, which was well controlled with topical corticosteroids. She reported new, sharp headaches in a headband distribution, exacerbated by lights, sounds, and neck flexion. One week prior to presentation, she experienced a subjective fever and recurrence of the facial rash. She denied experiencing eye pain, blurry vision, or light sensitivity. Results of a comprehensive review of systems were otherwise negative. Family history was notable for antiphospholipid syndrome in her mother. Best-corrected visual acuity was 20/25 OU. Results of an anterior segment examination, pupil examination, and tonometry were unremarkable. During dilated ophthalmoscopy, both eyes revealed diffuse intraretinal hemorrhages in the posterior pole and temporal retinal neovascularization, worse in the right eye with associated macular traction and striae. Both eyes demonstrated extensive peripheral vascular sheathing and retinal capillary nonperfusion (Figure 1).

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