Retina

Case 13

Patient Presentation: A 56-year-old female was referred to ophthalmology after she noticed blurred central vision in both eyes over a period of 2 months. She is currently taking medications for rheumatoid arthritis. On examination, vision is 20/30 in both eyes. Fundus photographs demonstrate non-specific RPE changes in the macula. The OCT macula is shown below:

Question: Using the OCT above, can you determine if it is the right or left eye?

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Question: What section is abnormal on the above OCT image?

Question: Based on the patient's history and OCT findings, what medication(s) is the likely cause of this?

A. Tamoxifen

B. Hydroxychloroquine

C. Chlorthalidone

D. All of the Above

Question: What sign on macula OCT is associated with this toxicity?

Learning Objectives:

1. Plaquenil toxicity results in disruption of the outer retinal layers. By the time macular toxicity is evident clinically on retinal examination or OCT, advanced disease is already present.

2. Saucer sign is the classic OCT sign associated with plaquenil toxicity and occurs due to the relative sparing of the subfoveal structures relative to the para-foveal loss of the outer retinal structures.

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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

Retina

Case 13

Question: Using the OCT above, can you determine if it is the right or left eye?

Question: What section is abnormal on the above OCT image?

Question: Based on the patient's history and OCT findings, what medication(s) is the likely cause of this?

Question: What sign on macula OCT is associated with this toxicity?

Learning Objectives:

1. Plaquenil toxicity results in disruption of the outer retinal layers. By the time macular toxicity is evident clinically on retinal examination or OCT, advanced disease is already present.

2. Saucer sign is the classic OCT sign associated with plaquenil toxicity and occurs due to the relative sparing of the subfoveal structures relative to the para-foveal loss of the outer retinal structures.

Retina

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Case 13

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Question: Using the OCT above, can you determine if it is the right or left eye?

Question: What section is abnormal on the above OCT image?

Question: Based on the patient's history and OCT findings, what medication(s) is the likely cause of this?

Question: What sign on macula OCT is associated with this toxicity?

Learning Objectives:

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1. Plaquenil toxicity results in disruption of the outer retinal layers. By the time macular toxicity is evident clinically on retinal examination or OCT, advanced disease is already present.

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2. Saucer sign is the classic OCT sign associated with plaquenil toxicity and occurs due to the relative sparing of the subfoveal structures relative to the para-foveal loss of the outer retinal structures.