Neuroretinitis

History of Present Illness (HPI)

A 36-year-old woman with no past ocular history and no significant past medical history complains of increasingly blurry vision in the right eye (OD). It started 2 weeks ago with some mild blurriness that has progressed to the point of a fuzzy gray spot in the center of her vision. The left eye (OS) seems the same as usual. In the last few days she has noticed some new floaters in the right eye as well ( Fig. 55.1 ).

Questions to Ask

• Do you have any pets or have you had interactions with animals in the past few months?

• Have you had unprotected sex?

• Any recent injuries or scratches?

• Have you traveled outside the United States recently?

She responds that she lives with two cats, but does not recall any recent trauma. She denies unprotected sex or traveling outside the country.

Assessment

• Neuroretinitis with mild vitritis OD

Differential Diagnosis

• Syphilis

• Bartonella

• Lyme disease

• Sarcoidosis

• Leber stellate neuroretinitis

• Systemic hypertension

• Less likely: toxoplasmosis, leptospirosis, tuberculosis, anterior ischemic optic neuropathy, Rocky Mountain spotted fever