PUBLICATION EXCLUSIVE: Young woman who went blind in one eye presents years later with symptoms in fellow eye

A 21-year-old Hispanic woman presented to the University of New Mexico with a 1-month history of worsening flashes of light and scotomas in her left superior field of vision.

Regarding her medical and ocular history, the patient had previously been diagnosed with a “generalized vasculitis.” When she was 14 years old, she developed joint pain in her wrists, ankles and knees. Within a week of the onset of the arthralgias, she also lost vision in the right eye and has since only seen bare light perception in that eye. She was followed by an outside ophthalmologist who told her he had seen “inflammation and a vitreous hemorrhage” in her right eye. She subsequently had a vitrectomy with no improvement in her vision. According to the patient, she had a complete systemic workup at that time that was unremarkable. Medical records provided by the patient indicated that her working diagnosis was “lupus retinal vasculitis.” However, the patient refuted this diagnosis, reporting that she had tested negative. She was followed closely by a rheumatologist who had prescribed her a high dose of methotrexate, which she was able to be weaned off within 2 years at age 16 given that she had not experienced any subsequent flares. Since that time, she had moved to Albuquerque, New Mexico, but had not re-established immediate care with a new rheumatologist.

Two months before her initial presentation, she developed recurrent joint pain but was unable to see a rheumatologist. A month later, she began to see intermittent flashes of light as well as dark areas in the superior visual field of her left eye, but the patient reported that these quickly resolved. A week later, she developed a new rash on her lower extremities, at which time her primary care physician started her on 2.5 mg of methotrexate as she was unable to establish immediate care with a rheumatologist. She became frustrated when she had no improvement so she went to an outside emergency room where she was prescribed 60 mg of prednisone 4 days before presentation. The patient again began experiencing visual disturbances in her left eye, with the flashes of light and scotomas becoming constant. At this point, she feared that she could become blind in her remaining good eye, so she presented to the University of New Mexico Emergency Department, where she was admitted for further management and workup.

Click here to read the full publication exclusive, Grand Rounds at the New York Eye Center, published in Ocular Surgery News U.S. Edition, June 25, 2017.