Intermittent Temporal Visual Field Loss in a Middle-aged Man

Abstract

A 45-year-old man presented with floaters in his left eye and headaches for 2 months. He experienced left temporal field loss when lifting heavy objects. He took no medications and denied prior surgery, eye trauma, or pain. His best-corrected visual acuity was 20/25 OD and 20/30 OS. The only abnormalities on bilateral eye examination were 1+ levels of anterior vitreous cells and trace levels of posterior vitreous cells in the left eye, without vitreous haze, and a left retinal detachment extending from 1:30 to 10:00 o'clock, with macular involvement and without visible retinal tears. There were 360°left choroidal detachments.Optical coherence tomography showed choroidal thickening in both maculae. Fluorescein angiography (FA) of the right eye gave normal results. Figure 1A depicts the FA image of the left eye. On B-scan ultrasonography, there was a subclinical choroidal detachment superonasally in the right eye. An ultrasonographic image confirmed the detachments in the left eye (Figure 1B). The findings of a prior magnetic resonance image of the brain, chest radiographic image, and computed tomographic image of the chest were unremarkable. Test results for syphilis, tuberculosis, bartonella, and toxoplasma were negative, as were test results for inflammatory markers, quantitative serum proteins, and immunoglobulins.The patient started receiving 60 mg of oral prednisone daily. Three weeks later, his bestcorrected visual acuity worsened to 20/50 OS. A posterior sub-Tenon injection of 40 mg of triamcinolone acetonide was given, along with tapering doses of oral prednisone for 6 more weeks. There was further decline in visual acuity to 20/60 OS and worsening subretinal fluid.

Rapidly Progressive Bilateral Visual Acuity Loss in a Middle-Aged Woman

“…Frequent reexamination should be performed in cases of exudative detachment to exclude a tear. Surgery to create scleral windows (choice D) would be appropriate for uveal effusion syndrome, which can also present with bilateral exudative detachments . However, uveal effusion syndrome would not present with robust inflammation.…”