Uveitis

Case 8

Patient Presentation: A 21-year-old male was referred for a 1-month history of acute onset metamorphopsia in his left eye.  His past ocular and medical history was non-contributory, and he did not endorse any family history of vision problems.  He was otherwise well with no recent illnesses on presentation.  On examination, his BCVA was 20/20 OU with a refraction of -7.00 OU.  There was no RAPD and the IOP was 13 OD and 14 OS. There was no anterior segment inflammation or vitritis seen on slit lamp exam. Optos fundus photography and fundus autofluorescence were performed and is shown below: 

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Question: Please describe the main findings.

Question: Based on the fundus images, which of the following is on your differential?

You order serologic testing for syphilis, lysozyme, angiotensin-converting enzyme and a chest x-ray to evaluate for underlying sarcoidosis, and quantiferon for possible tuberculosis, all of which return negative. An OCT macula is performed and shown below:

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Question: Describe the findings on the OCT

Question: Which of the following is the most common complication associated with punctate inner choroidopathy?

Learning Objectives:

1. To recognize clinical characteristics of punctate inner choroidopathy lesions that help distinguish it from other white dot syndromes.
2. To recognize key features of active vs inactive lesions of punctate inner choroidopathy on OCT.