History of Present Illness
A 62-year-old Caucasian male presents with 3 days of painless vision loss in the left eye (OS).
Past Medical History
Human immunodeficiency virus (HIV) on antiretrovirals
Examination Findings
Exam
| OD | OS | |
|---|---|---|
| Visual acuity | 20/20 | Count fingers |
| Intraocular pressure | 12 | 13 |
| Pupils | 5 mm → 3 mm, no APD | 5 mm → 3 mm, no APD |
| External | Normal | Normal |
| Lids/lashes | Normal | |
| Conjunctiva/sclera | White and quiet | White and quiet |
| Cornea | Clear | Clear |
| Anterior chamber | Deep and quiet | Deep and quiet |
| Iris | Round, reactive, no atrophy, no lesions | Round, reactive, no atrophy, no lesions |
| Lens | Mild nuclear sclerosis | Mild nuclear sclerosis |
| Vitreous | No vitreous cell/haze | No vitreous cell/haze |
| Dilated Fundus Examination (DFE) | See Fig. 41.1A | See Fig. 41.1B and C |
(A) Color fundus photograph of the right eye shows mild disc edema. (B) Standard color fundus photograph and (C) wide-field photograph demonstrate a large posterior area of chorioretinitis.
Given the disc edema right eye (OD) and chorioretinal lesion OS, fluorescein angiography and optical coherence tomography were pursued ( Figs. 41.2 and 41.3 ).
(A) Fluorescein angiogram of the right eye shows disc leakage. (B) A mid-to-late frame fluorescein angiography (FA) of the left eye shows mild disc leakage and leakage within the macula.
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