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Immune Checkpoint Inhibitor-Induced Panuveitis

History of Present Illness A 58-year-old man complains of progressive decrease in vision in both eyes (OU) over the last month. His past medical history is notable for metastatic cutaneous melanoma. He dismissed his symptoms initially, but after his vision did not improve spontaneously—in fact, he thinks it probably worsened over that time—he presented to a local ophthalmologist who then referred him on an expedited basis…

MEK Inhibitor-Associated Retinopathy (MEKAR)

History of Present Illness (HPI) A 69-year-old woman with a history of cutaneous melanoma complains of a change in her vision for the last month or so. She has difficulty describing her symptoms, but she reports that things are just a bit out of focus in both eyes (OU). She denies any other eye symptoms and has not had any recent changes to her health or…

Acute Exudative Polymorphous Vitelliform Maculopathy

History of Present Illness (HPI) A 61-year-old woman with a remote history of laser-assisted in situ keratomileusis (LASIK) both eyes (OU) is referred to you for evaluation of posterior uveitis. She noticed a “grayish smudge” in the center, OU, starting about 2 months ago. She saw an outside ophthalmologist, who noted posterior pole lesions, started prednisolone acetate eye drops four times a day (QID), ordered basic…

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…

Vogt-Koyanagi-Harada Disease

History of Present Illness A 31-year-old healthy woman with no significant past medical history presents to the eye clinic for the first time complaining of progressively decreased vision over the last 2 weeks. She notes that it first started in the left eye (OS) with mild sensitivity to light, followed quickly by blurred vision. She noticed similar symptoms in the right eye (OD) a few days…

Cytomegalovirus (CMV) Retinitis

History of Present Illness Cc : Weight loss over the past 3 months, with onset of floaters OU over the past 6 weeks A 38-year-old man presents in the emergency department (ED) with blurred vision in the right eye (OD) and floaters in both eyes (OU) over the past 6 weeks. He is an artist who lost 24 pounds over the past 3 months and has…

Systemic Lupus Erythematosus with Retinal Vasculitis

History of Present Illness A 36-year-old female presented with complaints of blurred vision in both eyes (OU). In 1990, at the age of 15, she had developed butterfly-shaped skin lesions on the face; treatment was unspecific. In 1993, swelling and pain of the knee and small joints of both hands occurred. She was now found positive for antinuclear antibodies (ANA) leading to the diagnosis of systemic…

Toxocariasis

History of Present Illness It is the beginning of the school year for first graders. An eye examination is required, and a 6-year-old girl has best corrected visual acuity (VA) 20/20 right eye (OD) and 20/80 left eye (OS). She is otherwise is in good health. Her mother has noticed that she does not see objects or people coming from either side. She has no history…

Severe, Atypical Toxoplasmosis

History of Present Illness (HPI) A 64-year-old man presents complaining of decreased vision in his right eye (OD). He is positive for human immunodeficiency virus (HIV) and has a history of cytomegalovirus (CMV) retinitis, left eye (OS), complicated by recurrent retinal detachment and ultimately phthisis bulbi OS. Exam OD OS Vision: 20/40 No light perception (NLP) Intraocular pressure (IOP): 22 4 Lids and lashes: Normal Ptotic…

Toxoplasmosis

History of Present Illness A 27-year-old woman with no significant past ocular history or medical history complains of new floaters in the left eye (OS) for 3 days. She states her vision is also blurred in this eye. She has no complaints in the other eye. Exam OD OS Vision: 20/20 20/30− Intraocular pressure (IOP): 11 19 Lids and lashes: Normal Normal Sclera/conjunctiva: White and quiet…

Progressive Outer Retinal Necrosis (PORN)

History of Present Illness (HPI) A 24-year-old jazz musician noticed poor vision, both eyes (OU), about 3 months ago. He has not been feeling well recently, but attributed that to his odd hours of work and little sleep. He has no history of vision problems, although he was hit in his left eye (OS) as a child and required stitches to close his skin wound. His…

Acute Retinal Necrosis (ARN)

History of Present Illness A 38-year-old black Haitian male presented with worsening vision and floaters in his right eye (OD) for the past 2 weeks. The day before symptoms started, the patient felt a foreign body sensation while cutting lumber. He was evaluated by an outside physician, who started the patient on difluprednate drops without improvement. Exam OD OS Visual acuity 20/200+1 sc PH no improvement…

Endogenous Endophthalmitis

History of Present Illness The coronary care unit has consulted ophthalmology regarding a 46-year-old male inpatient who complains of decreased vision in his right eye (OD). He has had a protracted course in the hospital. He presented 2 weeks ago with ST-elevation myocardial infarction complicated by cardiogenic shock. He underwent emergent coronary artery stenting of the left anterior descending artery. He has been on multiple vasopressors…

Exudative Retinal Detachment

History of Present Illness (HPI) A 42-year-old man with no significant past ocular or medical history complains of progressively decreased vision in his right eye (OD) over the last 1 to 2 months. He says he can only see a small sliver of the world out of the bottom portion of the right eye. He denies problems in the left eye (OS). Exam OD OS Vision…

Diffuse Unilateral Subacute Neuroretinitis (DUSN)

History of Present Illness A 56-year-old man presents with a paracentral blind spot and floaters right eye (OD), but no ocular pain, for about 4 weeks. He first noticed the blind spot while hunting in Michigan and closing his left eye (OS). He has been in excellent health and enjoys hunting, fishing, and swimming in the outdoors. He does not recall being bitten by an insect…

Tuberculous Uveitis

History of Present Illness A 25-year-old man noticed the vision in his left eye (OS) became blurry 2 weeks ago and is associated with a productive cough. His appetite has been poor recently, and he has lost 20 pounds in the past 2 months. Exam OD OS Visual acuity 20/25 20/100 Intraocular pressure (IOP) 11 7 Sclera/conjunctiva Within normal limits (WNL) Clear, no injection Cornea Clear…

Syphilitic Uveitis and Outer Retinopathy

History of Present Illness A 28-year-old Caucasian man with complains of mild redness, floaters, photophobia, and blurred vision in both eyes (OU) that began 2 weeks ago. He previously had excellent visual acuity (VA) with a mild myopic correction. He mentions that he has lost 20 pounds over the past 2 months and has malaise and weakness. Exam OD OS Visual acuity 20/40 20/30 Intraocular pressure…

Syphilitic Posterior Placoid Chorioretinitis

History of Present Illness A 62-year-old Caucasian male presents with 3 days of painless vision loss in the left eye (OS). Past Medical History Human immunodeficiency virus (HIV) on antiretrovirals Examination Findings Exam OD OS Visual acuity 20/20 Count fingers Intraocular pressure 12 13 Pupils 5 mm → 3 mm, no APD 5 mm → 3 mm, no APD External Normal Normal Lids/lashes Normal Conjunctiva/sclera White…

Hemorrhagic Occlusive Retinal Vasculitis

History of Present Illness A 70-year-old man with a history of hypertension, hyperlipidemia, and emphysema presented to an optometrist with sudden loss of vision in the left eye (OS) 2 weeks after seemingly uncomplicated cataract surgery. Uncorrected visual acuity was 20/20 1 day after cataract surgery. The sudden loss of vision occurred over a 10-minute period while eating dinner. He presented to an optometrist, who suspected…

Melanoma-Associated Retinopathy

History of Present Illness A 30-year-old male with a history of melanoma presents for the first time to the eye clinic complaining of some distortion of images in the left eye (OS). He noticed that in his OS he now sees “through a screen of colored squiggly lines and white dots.” It was hard for the patient to look at dark backgrounds. Initially, these symptoms were…