July 25, 2017
2 min read
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PUBLICATION EXCLUSIVE: Man presents with blurry vision, flashes, floaters and redness

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A 53-year-old Caucasian man presented with a 3-week history of worsening blurry vision of the left eye associated with flashes, floaters and redness. He also complained of a recent fever that lasted 2 weeks and resolved on its own. He noted that he recently had a “sore” in his mouth that also resolved.

The patient had a medical history of hypertension and hyperlipidemia. His ocular history was significant only for refractive error. He denied any tobacco use and reported social alcohol use. He had no pets at home. He worked as a chef, often working with raw or undercooked meat. He noted that his wife recently had a cold sore, and he had chicken pox as a child.

Examination

Uncorrected visual acuity was 20/25 in the right eye and 20/50 in the left eye. Both pupils were equally round and briskly reactive with no afferent pupillary defect. IOP, confrontational visual fields and extraocular movements were normal in both eyes. Anterior segment examination was within normal limits in the right eye, and the left eye had diffuse keratic precipitates with 2+ cell and flare of the anterior chamber. Anterior vitreous was clear in the right eye, and there were 2+ anterior vitreous cells in the left eye with 2+ haze. Fundus examination of the right eye was within normal limits, while the left eye had a single discreet nasal patch of retinitis near the optic nerve with sheathing of arterioles emanating from the optic nerve nasally (Figure 1).

Figure 1. Mosaic photo of left eye showing a single discreet nasal patch of retinitis near the optic nerve with sheathing of arterioles emanating from the optic nerve nasally.

Images: Witkin D, Witkin A

Figure 2. OCT of the macula of the left eye (top). OCT through the patch of retinitis in the left eye (bottom).

OCT of the maculae of both eyes was within normal limits without intraretinal fluid or subretinal fluid, although there was a slight irregularity of the foveal retinal pigment epithelium in the left eye. OCT signal of the left eye was also attenuated by vitreous haze. OCT through the lesion of retinitis in the left eye showed diffuse hyperreflectivity involving all retinal layers without associated intraretinal or subretinal fluid (Figure 2). The patient was unable to tolerate fluorescein angiography due to vomiting and hypotension.

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