A 17-year-old man, originally from Sierra Leone, presented to the Wilmer Eye Institute with blurry vision in his right eye and occasional achy pain in and behind the eye. He had visited his primary care physicians several weeks ago with similar symptoms where he was diagnosed with conjunctivitis and offered topical antibiotics. He did not respond to the treatment and was referred for further evaluation. The patient is generally healthy, but does have a history of hepatitis B after a blood transfusion in his native country many years ago during surgery for an abdominal trauma. Other surgical history is significant for hernia repair.The patient's social history includes living with his adopted mother, biologic father, and adopted grandmother for approximately 10 years, before which he lived in the aforementioned African nation. He has both a dog and cat at home. He has been working with his father on his farm for the past few months in West Virginia, but reports no major accidents or illnesses contracted. He admits to smoking marijuana once or twice weekly for 1 year, but no other recreational drug use. He is sexually active and uses protection most of the time. Family history is not known on his biologic mother's side, but negative on his father's side for any chronic illnesses or genetic conditions. Careful review of systems is noncontributory. Medical records from Sierra Leone indicated that the patient did receive vaccination for mumps, measles, and rubella, among others, but did not receive Bacille-Calmette-Guérin vaccination for tuberculosis.On presentation to our clinic, the visual acuity without correction was 20/50, pinhole to 20/25 in the right eye, and 20/15 in the left eye. Intraocular pressure was 13 in each eye. Slit-lamp examination revealed mild conjunctival injection and diffuse mutton-fat precipitates in the anterior chamber with 2ϩ cells and flare in the right eye. There was no pupillary synechiae. Slit-lamp examination of the left eye revealed no abnormality. Funduscopic examination of the right eye showed 1ϩ suspended cells in the anterior vitreous; there was no disk edema ( Figure 1A). Throughout the peripheral retina, there were vitreous clumps as well as sheathing of blood vessels. In the superotemporal quadrant, a well-demarcated, elevated, creamy-white chorioretinal lesion ( Figure 1B) was noted. There was a layer of cells overlying the lesion. No peripheral exudates were seen. Funduscopy of the left eye revealed no vitreous cells or other vitreo-retinal pathology.Imaging studies included red-free fundus photography ( Figure 1C), fluorescein angiography, and optical coherence tomography. Fluorescein angiography of the right eye demonstrated hyperfluorescence with late leakage of the superior and inferior vessels; the chorioretinal lesion was hypofluorescent with a border of hyperfluorescence and an area of nonperfusion immediately surrounding it (Figures 1, D-F). Fluorescein angiography of the left eye demonstrated normal vasculature. Optical coherence tomography demonstrated absence of m...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.