A 12-year-old Caucasian male with progressive blurred vision, photophobia and pressure-like pain in his right eye presented to the Wills Eye emergency room. Symptoms were noted two days prior when he was playing soccer and had to step off the field due to excessive photophobia of his right eye, which was also red. His left eye was asymptomatic. He didn’t sustain any ocular trauma and was otherwise in his usual state of good health.
There was no past ocular history. The past medical history revealed mild intermittent asthma. Family history included glaucoma in his grandmother and a cerebrovascular accident in his grandfather. Social history was negative for recent travel or contact with cats or dogs but included contact with a family-owned farm that raised free-range chickens. He had no known allergies and took no medications.
On ocular examination, visual acuity was 20/20 OU. Pupils were normal. Intraocular pressure was 30 mmHg OD and 14 mmHg OS. Confrontation visual fields and ocular motility were full bilaterally. The anterior segment examination of the right eye revealed mild injection of the conjunctiva temporally, stellate inferior keratic precipitates, 1+ cell and trace flare, and moderate vitreous cell. The left eye was unremarkable.
On fundus examination of the right eye there was blurring of the nasal margin of the optic disc and a partial macular star without edema. An elevated white retinal lesion with associated subretinal fluid, vitritis, vasculitis and intraretinal hemorrhage, suggestive of an inflammatory mass, was identified in the inferotemporal midperiphery (Figure 1).
|Figure 1. (A) Wide-angle fundus photograph of the right eye showing (B) a yellow-white mass in the temporal macular region with overlying vitritis and surrounding retinal vasculitis with hemorrhage, partial macular star in the |
temporal macula and mild optic disc edema nasally. The left eye (C) was normal.
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