History of Present Illness A 28-year-old female in Monrovia, Liberia, presents with blurry vision in both eyes (OU). She has a past medical history of Ebola virus disease (EVD) diagnosed 6 months before her initial presentation. Vision loss in the right eye (OD) occurred 3 days after discharge from an Ebola treatment unit with subsequent loss of vision in the left eye (OS). Other associated symptoms…
History of Present Illness A 54-year-old Caucasian female with long-standing rheumatoid arthritis complains of severe right eye (OD) pain and redness for 1 week. The symptoms respond minimally to ibuprofen. She has had similar pain in both of her eyes in the past couple of years and was treated with topical corticosteroid drops and oral nonsteroidal antiinflammatory drugs (NSAIDs) by her ophthalmologist. Her current medications include…
History of Present Illness (HPI) A 68-year-old woman with a history of non–insulin-dependent diabetes mellitus type 2, rheumatoid arthritis, and scleritis left eye (OS) complains of increasing pain and redness in her OS. Her scleritis has been difficult to control in the past, and last year the dosing of adalimumab was increased from 40 mg subcutaneous (SC) every 2 weeks to every week. She had to…
History of Present Illness A 39-year-old woman with no past medical history presents for the first time to the eye clinic complaining of redness and irritation in the left eye (OS) for 3 days. It is just in the left-hand corner of the left eye and has not improved at all since it started. Exam OD OS Visual acuity 20/20 20/20 Intraocular pressure (IOP) 12 13…
History of Present Illness (HPI) A 35-year-old healthy woman with no significant past medical or ocular history is referred to the uveitis clinic by an outside ophthalmologist for “bilateral acute anterior uveitis.” She reports that her symptoms started a little over a month ago. Her eyes started to become red and very light sensitive. The referral note mentions that she was started on prednisolone acetate 1%…
History of Present Illness (HPI) A 63-year-old woman underwent cataract surgery in the left eye (OS) about 3 months ago. The case was reportedly uncomplicated, and a one-piece intraocular lens (IOL) was placed in the capsular bag. Since then, she has had multiple episodes of what her cataract surgeon called “rebound iritis.” She was tapered off prednisolone acetate four times a day (QID) from postoperative week…
History of Present Illness A 7-year-old Caucasian boy complains of blurred visual acuity (VA), photophobia, and intermittent pain in both eyes (OU) over the past 12 months. Since age 3 he has had exacerbations of a papulonodular, tender, reddish-brown rash on his face ( Fig. 12.1 ) and trunk ( Fig. 12.2 ), as well as multiple firm subcutaneous nodules. The skin manifestations usually resolve with…
History of Present Illness A 42-year-old female with past medical history of biopsy-proven interstitial nephritis since 2008 presented for the first time 2 years after the onset of nephritis to the eye clinic with anterior uveitis that started 5 months ago. She was treated with systemic corticosteroids (CS). The treatment was stopped a month ago, and 3 days later she noticed worsening of vision ( Figs.…
History of Present Illness “My rheumatologist asked me to have an eye examination.” A 6-year-old girl with a recent diagnosis of juvenile idiopathic arthritis (JIA) is referred to an ophthalmologist for a routine eye examination. The child has no complaints, and the parents have not noticed any problem with her vision or eyes. She was diagnosed with JIA at 4 years of age, and previous eye…
History of Present Illness (HPI) A 39-year-old man with no significant past medical history complains of 2 days of tearing, light sensitivity, and blurry vision in his left eye (OS). It started first with some foreign body sensation and has progressed since then. His other eye is fine. He denies getting anything in the eye or being hit in the eye and denies contact lens use.…
History of Present Illness (HPI) A 52-year-old woman with no past ocular history is referred to you for anterior uveitis in the left eye (OS). She presented to an outside ophthalmologist 1 week ago with decreased vision and photophobia. Outside records note 4+ white cells in the anterior chamber. She was started on difluprednate six times a day OS and cyclopentolate three times a day (TID)…
History of Present Illness (HPI) A 46-year-old woman with a history of anterior uveitis in the left eye (OS) associated with HLA-B27 presents to you from an outside ophthalmologist for a second opinion. She had her first episode of iritis 7 years ago. She responded well to drops and did not recur for almost a year. In the last 1 to 2 years, her flares have…
History of Present Illness (HPI) A 58-year-old man with no significant past medical history presents for follow-up of anterior uveitis in the left eye (OS). He has been seen multiple times by outside ophthalmologists and has been on topical steroids for 2 months. He reports he has never been able to get off the steroids completely. He has had testing for an underlying cause of uveitis,…
History of Present Illness (HPI) A 67-year-old man presents 3 months after uncomplicated cataract extraction/intraocular lens implant (CE/IOL) right eye (OD) complaining of decreased vision and mild photophobia in the right eye. It has been progressive over the last 5 days. On postoperative day 1 after cataract surgery, he was 20/25− with 1+ white cells in the anterior chamber (AC) and trace corneal stromal edema, improving…
History of Present Illness (HPI) A 32-year-old man with no past ocular or medical history complains of 3 days of light sensitivity and redness in his left eye. He woke up with the symptoms and thought that maybe he had gotten something into his eye while sleeping. The symptoms have not improved and, he reports, have probably gotten worse. Exam OD OS Vision 20/20 20/25− IOP…
Introduction The goal of uveitis therapy is to suppress intraocular inflammation to zero or minimal activity and then maintain quiescence. In other words, excellent, enduring control is the goal. If we can achieve this, then patients are spared the multiple structural complications of uveitis that ultimately lead to vision loss, be they mild or severe: band keratopathy, synechiae, glaucoma, cyclitic membranes, hypotony, macular edema, epiretinal membranes,…
Introduction Patients are often preoccupied with the “cause” of their affliction. Although this is understandable, the etiology of a given uveitis syndrome is often elusive, and about half of cases are labeled idiopathic or undifferentiated. In contrast, for the clinician, the first goal of any diagnostic testing is to differentiate between infectious and noninfectious/inflammatory etiologies. A third important but rare category is ocular neoplasm masquerading as…
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Seventy percent of the total blood flow to the eye travels through the vascular network that is the choroid. Its primary function is to provide nutrients to the outer retinal structures, as well as the foveal avascular zone. However, there is evidence to suggest that the choroid has other roles including; thermoregulation in ocular tissues, modulation of intraocular pressure via vasomotor control of blood flow, and…
Choroidal Rupture Jorge Ruiz-Medrano Jay Chhablani Clínico San Carlos University Hospital, Ophthalmology Unit, Madrid, Spain LV Prasad Eye Institute, Hyderabad, India Abstract Choroidal ruptures involve a tear of the retinal pigment epithelium, Bruch’s membrane, and choroidal tissue as a consequence of trauma to the eye. Choroidal rupture caused by blunt trauma to the eye may occur at the site of the impact in the case of direct ruptures,…