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 systemic corticosteroids.
Exam
| OD | OS | |
|---|---|---|
| Visual acuity | 20/80 | 20/40 |
| IOP (mm Hg) | 22 | 21 |
| Sclera/conjunctiva | Clear. No injection. | Clear. No injection. |
| Cornea | Band keratopathy (BK) with subepithelial corneal opacities inferiorly | No BK but subepithelial corneal opacities (see Fig. 12.2A ) |
| AC | 2+ flare and 2+ cells | 2+ flare and 2+ cells |
| Iris | Pinpoint pupil with intermittent posterior synechiae for 360 degrees | Intermittent posterior synechiae for 360 degrees |
| Lens | 3+ Posterior subcapsular cataract (PSC) | 1+ PSC |
| Vitreous cavity | 2+ vitreous cells | 2+ vitreous cells |
| Retina/optic nerve | Fundus view blocked by pinpoint pupil and PSC | Disseminated chorioretinal lesions obscured by PSC and vitritis (see Fig. 12.2B ) |
Butterfly-shaped skin rash on the cheeks.
Picture credit: Ophthalmology . 2003;110(10):2040–2044, by Elsevier.
