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Case 54

Contributor: Dr. Austin Pereira and Dr. Keyvan Koushan 

Patient Presentation: A 50-year-old female was referred to a tertiary ophthalmology clinic for progressive blurred vision in both eyes. The patient’s past medical history included a scleral buckle retinal detachment in the right eye one year prior, with no subsequent complications. Her past medical history included enteric colitis, chronic bladder inflammation, arthritis and fibromyalgia; medications included: baclofen, cetirizine, mometasone cream, cortisone injections and elmiron. His family history was significant for age-related macular degeneration.

The patient’s best corrected distance visual acuity was 20/30 OD and 20/30 OS with pressures within normal limits. Pupils were equal and reactive to light. Anterior segment examination was unremarkable. Fundus examination demonstrated parafoveal hyperpigmentation at the macula, as demonstrated in the fundus photos below:

Retina 54-1.png
Retina 54-2.png

Bilateral OCT macula images were taken and are shown below:

Retina 54-3.png
Retina 54-4.png

Question: What feature is not present in the OCT macula images above?

Question: Based on the patient’s history, fundus examination findings and OCT macula imaging, what is the most likely diagnosis?

Question: What treatment is most efficacious in this patient scenario?

Learning Objectives:

  1. Differentiating Elmiron toxicity from macular degeneration and pattern dystrophy

  2. Utilizing OCT imaging to diagnose Elmiron toxicity

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