History of Present Illness
A 13-year-old boy presented with a history of decreased vision and pain in the right eye (OD) for the past 2 months. He reported a history of blunt trauma to this eye around the time his symptoms began. He had been treated for a presumed traumatic uveitis for the past 2 months.
Exam
| OD | OS | |
|---|---|---|
| Visual acuity | 20/30 | 20/20 |
| Intraocular pressure (IOP) | 30 | 18 |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Deposits on the corneal endothelium mimicking keratic precipitates (see Fig. 24.1B ) | Clear |
| Anterior chamber (AC) | Hypopyon-like layering of white material inferiorly (see Fig. 24.1A ) | Deep and quiet |
| Iris | Unremarkable | Unremarkable |
| Lens | White deposits on the anterior lens capsule. | Clear |
| Anterior vitreous | Vitreous seeding (see Fig. 24.1D ) | Clear |
Dilated Fundus Examination (DFE) (See Fig. 24.1D )
| Nerve: | cup-to-disc (c/d) 0.2, pink, sharp |
| Macula: | Normal |
| Vessels: | Normal caliber and course |
| Periphery: | Unremarkable |
(A) Color external photograph of the right eye shows a subtle pseudohypopyon in the anterior chamber. (B) Slit lamp photograph of the right eye reveals large white deposits on the corneal endothelium mimicking keratic precipitates. Deposits were also noted on the anterior lens capsule. These deposits are consistent with dispersed tumor cells. (C) B scan ultrasonography demonstrates an intraocular mass with calcification, with echoes in the vitreous suggestive of vitreous seeds. (D) Color fundus photograph of the right eye reveals a solid tumor mass in the inferior and inferonasal mid-periphery with diffuse vitreous seeding.
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