Gradual Loss of Vision and Chorioretinal Scarring
Gradual Loss of Vision and Chorioretinal Scarring
A 37-year-old man experienced impaired vision in both eyes. He first noticed this 6 months before presentation and the problem had been worsening. He had a history of ocular histoplasmosis with chorioretinal scarring in each eye. He said he did not drink alcohol or smoke tobacco. There was no family history of visual loss and he was taking no prescription medications.
Findings of his eye examination are as follows:
Figure. Bilateral optic disc edema and chorioretinal scars. Retinal hemorrhage visible on the left.
Other tests showed the following:
Clinical Presentation
A 37-year-old man experienced impaired vision in both eyes. He first noticed this 6 months before presentation and the problem had been worsening. He had a history of ocular histoplasmosis with chorioretinal scarring in each eye. He said he did not drink alcohol or smoke tobacco. There was no family history of visual loss and he was taking no prescription medications.
Findings of his eye examination are as follows:
Visual acuity was 20/20 in both eyes.
His present correction was -3.75 sphere in each eye.
Color vision with Ishihara pseudoisochromatic plates was 10/10 in both eyes.
Pupils were brisk, with no relative afferent pupillary defect.
Automated perimetry showed enlarged blind spots on each side.
Intraocular pressure was 19 mm Hg in each eye.
Slit lamp examination of the anterior segment was normal.
There were cells in the vitreous on each side, and the funduscopic examination (Figure) demonstrated slight optic disc edema on each side, with adjacent retinal hemorrhage on the left. Chorioretinal scars were observed on each side.
Figure. Bilateral optic disc edema and chorioretinal scars. Retinal hemorrhage visible on the left.
Other tests showed the following:
Intravenous fluorescein angiography showed no evidence of choroidal neovascularization.
MRI of brain and orbits with contrast and MRV of the brain were normal.
Lumbar puncture revealed an opening pressure of 23 cm of water. Cerebrospinal fluid (CSF) glucose was normal. Protein was elevated at 82 mg/dL and the white cell count was 24 cells/µL with 75% lymphocytes.
