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Contributor: Niveditha Pattathil, MD Candidate
Patient Presentation: A 43-year old Caucasian woman presented to a tertiary retina clinic with bilateral flashes of light for 2 weeks. She denied floaters, eye pain, or redness. She had no medical history other than an essential tremor. Review of systems elucidated that the patient had an occipital headache prior to her flashes starting. Uveitis review revealed no recent travel, atypical diet, high-risk sexual activity, or intravenous drug use.
Her best corrected vision was 20/20 in both eyes. Her intraocular pressures were normal. She did not have an RAPD. Her anterior exam was normal in both eyes, and Shafer sign was negative OU. Fundus examination appeared unremarkable other than the presence of asteroid hyalosis in the left eye. Optos fundus photographs are shown below:
Zeiss Cirrus HD-OCT macula images are shown below:
Question 1: What is the main abnormality seen in the OCT macula images above?
Optos fundus autofluorescence imaging is shown below:
Question 2: What main finding is noted on the fundus autofluorescence imaging?
Visual field testing (HVF 24-2) was performed and is shown below:
Question 3: Based on your assessment so far, what diagnosis is at the top of your differential?
Question 4: What investigation is important to order next for this patient?
Question 5: Which of the following is the optimal management plan for this patient?
Identify features on OCT and fundus autofluorescence imaging characteristic of syphilitic outer retinopathy
Understand the workup and management plan for patients presenting with syphilis infection
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