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Pars Planitis


History of Present Illness

A 15-year-old healthy boy with no past medical history presents for the first time to the eye clinic complaining of blurred vision in his left eye (OS). He noticed some change about a month ago and now notices a significant difference between the two eyes, especially when he plays football. He also complains of floating spots in the OS ( Figs. 21.1 and 21.2 ).

Exam
OD OS
Visual acuity 20/20 20/40−
Intraocular pressure (IOP) 15 14
Sclera/conjunctiva White and quiet White and quiet
Cornea Clear Clear
AC Deep and quiet {1/2}+ white cells, 1+ flare
Iris Unremarkable Unremarkable
Lens Clear Clear
Anterior vitreous Clear 1+ cells

Fig. 21.1, (A) Color fundus photograph of the left eye shows hazy media consistent with vitritis and multiple snowballs. (B) Color fundus photograph of the left eye temporal to the macula shows vascular sheathing.

Fig. 21.2, (A) Optical coherence tomography (OCT) of the right eye shows normal macular structure and trace posterior vitreous cell. (B) OCT of the left eye shows normal macular structure without cystoid macular edema but with degraded image quality, increased hyperreflectivity of the vitreous, and posterior vitreous cells consistent with vitreal inflammation.

Questions to Ask

  • Do you notice anything in the right eye (OD)?

  • Have you ever had any numbness, tingling, weakness on one side of the body, or bowel or bladder problems? Is there any history of neurologic disorders in the family?

  • Have you noticed any recent ticks or tick bites on your body? Do you go camping at all or spend much time outdoors?

He answers no to all of the questions.

Assessment

  • Intermediate uveitis OS > OD with mild periphlebitis both eyes (OU)

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