Hypopyon uveitis





History of present illness


A 20-year-old woman of Middle Eastern descent presented because of acute onset of floaters, decreased vision, and redness in the left eye without pain, photophobia, or other ocular symptoms. She was evaluated by her referring provider and diagnosed with uveitis with cystoid macular edema and started on topical corticosteroid. Upon completion of corticosteroid taper, the patient developed recurrent uveitis in the left eye with development of decreased vision in the right eye and was referred for assessment.


Questions to ask




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    Does the patient have an ocular history that could be associated with her symptoms? Has she been diagnosed with myopia? Are these any symptoms suggestive of prior uveitis in both eyes?


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    Systemic symptoms: Does the patient have any history of recurrent oral ulcers, intermittent tinnitus, or joint pain in hands and feet?


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    Family history: Is there any history of autoimmune hepatitis, psoriasis, or leukemia?


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    Social and travel history: Does the patient own any cats? Is there any history of alcohol, tobacco, intravenous drug use, high-risk sexual activity, or recent travel?



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      The patient owns one cat and has experienced bites and scratches. She denies a history of alcohol, tobacco, intravenous drug use, high-risk sexual activity, or recent travel.




Ocular exam findings


Visual acuity was counting fingers at 2 inches in the right eye and light perception in the left eye. Intraocular pressures were normal. The external examination was normal . Anterior segment examination showed mild conjunctival injection with ciliary flush, 4+ pigmented and white blood cells with mild flare in both eyes. An inferior hypopyon was present in the right eye.


Dilated fundus examination showed 3+ vitreous cell bilaterally with 1+ haze in the right eye and 2 to 3+ haze in the left eye. The right optic nerve was hyperemic and edematous. Scattered areas of inner retinal whitening were noted in the right eye with sheathing of the arterioles and venules. Details of the optic nerve, macula, vessels, and periphery in the left eye were limited due to vitritis.


Imaging


Optos ultra–wide-field color fundus photographs ( Figs. 25.1 and 25.2 ) were obtained. Fig. 25.1 demonstrates hyperemia with disc edema, patches of retinitis within the macula, diffuse vasculitis, and patches of retinitis in all four quadrants with a small inferotemporal hemorrhage. Fig. 25.2 demonstrates significant media opacity secondary to vitreous cells with optic nerve head edema.




Fig. 25.1


Optos ultra–wide-field color fundus photograph of the right eye demonstrating diffuse foci of deep retinal white lesions.



Fig. 25.2


Optos ultra–wide-field color fundus photograph of the left eye demonstrating diffuse media opacity.


Spectral domain optical coherence tomography (OCT) demonstrated macular edema bilaterally with outer retinal cysts and subretinal fluid in the right eye. Nasal retinal edema was observed in the left eye ( Figs. 25.3 and 25.4 ).




Fig. 25.3


Optical coherence tomography of the right eye demonstrating vitreous opacities, inner retinal thickening, outer retinal edema, and subretinal fluid. The choroid appears normal.



Fig. 25.4


Optical coherence tomography of the left eye demonstrating inner retinal thickening, outer retinal edema, and subretinal fluid. The choroid appears normal. More significant inner retinal edema is present adjacent to the optic nerve head.


Optos ultra–wide-field fluorescein angiogram (FA) showed arteritis and phlebitis bilaterally in the mid to late phase with disc staining. Early blockage in the areas of retinitis with late staining was observed ( Figs. 25.5–25.8 ).


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Jun 15, 2024 | Posted by in OPHTHALMOLOGY | Comments Off on Hypopyon uveitis

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