History of Present Illness
A 62-year-old man noticed difficulty shooting his rifle when looking through the mount with his left eye (OS) 1 week ago. Over the next few days he observed floaters and paracentral scotomas OS. Since then he has been testing his vision and noticed that similar changes have occurred in the right eye (OD). He had no history of systemic illness and was otherwise in good health.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/23 | 20/84 |
| Intraocular pressure (IOP) (mm Hg) | 10 | 11 |
| Sclera/conjunctiva | Clear. No injection | Clear. No injection |
| Cornea | Rare nongranulomatous (NG) keratic precipitates (KPs) | Rare NG KPs |
| Anterior chamber (AC) | 1+ cell, trace flare | 1+ cell, trace flare |
| Iris | Normal | Normal |
| Lens | Clear | Clear |
| Vitreous cavity | Trace vitreous cells | Trace vitreous cells |
| Retina/optic nerve | Similar to OS | See Fig. 35.1 . Creamy white lesions in outer retina <{1/2} disc area extending to periphery, with more than 50 lesions throughout the fundus |
Questions to Ask
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Have you had acute visual loss in either eye before?
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Have you experienced a flulike illness with malaise, lethargy, or tiredness?
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Have you been diagnosed with a blood or bone marrow disorder in the past?
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Are you being treated for any systemic disease affecting other organs?
The patient denies a previous history of acute visual loss, as well as any prodromal illness. He recently underwent a complete annual examination and is in good health with normal complete blood count (CBC) and urinalysis.
Assessment
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White dot syndrome, both eyes (OU), with lesions distributed throughout the retina. Over the ensuing weeks, some of the lesions enlarged and others resolved ( Fig. 35.2 ).
