History of Present Illness
A 63-year-old woman presents with small light flashes in both eyes (OU) that interfere with her ability to see. The flashes have different color patterns. She especially has difficulty seeing in bright lighting.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/25 | 20/25 |
| Intraocular pressure (IOP) | 19 | 19 |
| Sclera/conjunctiva | Normal | Normal |
| Cornea | Normal | Normal |
| Anterior chamber (AC) | Normal | Normal |
| Iris | Normal | Normal |
| Lens | 1+ nuclear sclerosis | 1+ nuclear sclerosis |
| Vitreous | Normal | Normal |
| Dilated Fundus Examination (DFE) | See Fig. 38.1A | See Fig. 38.1B |
Because the fundus examination was unremarkable aside from mild vessel attenuation, autofluorescence imaging ( Fig. 38.2 ) and optical coherence tomography (OCT) of the macula (not shown) were pursued. OCT was within normal limits OU.
Questions to Ask
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Do you or does anyone in your family have a history of cancer?
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Do you have a family history of retinal disease?
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Do you have a history of liver disease?
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Have you ever had bariatric surgery?
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Are you currently on any medications?
The patient is currently on levothyroxine for hypothyroidism and cetirizine for seasonal allergies. Her mother has a history of breast cancer and father of gastric cancer. She answers no to all other questions.
Assessment
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Occult retinopathy OU
Differential Diagnosis
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Retinal toxicity from medications
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Vitamin A deficiency
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Autoimmune retinopathy (AIR)
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Nonparaneoplastic AIR
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Cancer-associated retinopathy
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Inherited retinal degeneration
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Acute zonal occult outer retinopathy (AZOOR)
Further Testing
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Visual field testing ( Fig. 38.3 )
