History of Present Illness
A 25-year-old man noticed the vision in his left eye (OS) became blurry 2 weeks ago and is associated with a productive cough. His appetite has been poor recently, and he has lost 20 pounds in the past 2 months.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/25 | 20/100 |
| Intraocular pressure (IOP) | 11 | 7 |
| Sclera/conjunctiva | Within normal limits (WNL) | Clear, no injection |
| Cornea | Clear | Multiple multifocal (MF) keratic precipitates (KPs) on corneal endothelium |
| Anterior chamber (AC) | WNL | 3+ flare and 3+ cell |
| Iris | WNL | Intermittent posterior synechiae, Koeppe iris nodules on pupillary margin ( Fig. 43.1 ) |
| Lens | Clear | Clear |
| Vitreous cavity | Clear | 2+ vitreous cell |
| Retina/optic nerve | Choroidal mass in posterior pole ( Fig. 43.2 ), with retinal vasculitis and perivascular sheathing. Mild optic disc swelling at temporal margin |
Questions to Ask
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Have you had blurry vision in either eye before?
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Why have you been losing weight? Is your appetite good?
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Have you been diagnosed with a systemic illness?
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What medications are you taking?
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Have you been exposed to anyone with a contagious disease?
He has not had blurry vision before. His appetite is poor, which he attributes to his recent chest infection. He is gay, and 2 years ago he was diagnosed positive for human immunodeficiency virus (HIV). He is currently on highly active antiretroviral therapy (HAART), and about 1 month ago visited a friend who had recently been diagnosed with pneumonia.
