History of Present Illness
A 30-year-old male with a history of melanoma presents for the first time to the eye clinic complaining of some distortion of images in the left eye (OS). He noticed that in his OS he now sees “through a screen of colored squiggly lines and white dots.” It was hard for the patient to look at dark backgrounds. Initially, these symptoms were intermittent and then became constant within a week of onset.
Exam
| OD | OS | |
|---|---|---|
| Visual acuity | 20/25+ | 20/20 |
| Intraocular pressure (IOP) | 14 | 14 |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Clear | Clear |
| Anterior chamber (AC) | Deep and quiet | Deep and quiet |
| Iris | Unremarkable | Unremarkable |
| Lens | Clear | Clear |
| Anterior vitreous | 2+ cell | 2+ cell |
| Dilated Fundus Examination (DFE) | See Fig. 39.1 |
Given the history of nyctalopia in the setting of a normal fundus, electroretinogram (ERG) is pursued ( Fig. 39.2 ).
(A) Ultrawide-field fundus photograph of the right eye showing clear media and normal appearance of the vessels and a flat, small, choroidal nevus inferiorly ( asterisk ). (B) Normal short-wavelength autofluorescence imaging. (C) Fluorescein angiogram (FA) 7 minutes after administration of contrast showing mild perivascular staining/trace leakage ( arrow ) of vessels within the arcades. (D) Near infrared reflectance shows hyporeflectance along vessels (arrow) that were abnormal on FA. (E) Spectral domain optical coherence image extending 9 mm from the foveal center into the superior near midperiphery is within normal limits. The clinical picture is nearly the same for the left eye.
