Ocular Inflammation and a Neglected Neck Mass

Stephanie A. Klemencic, OD; Tricia L. Newman, OD


December 13, 2012

Clinical Presentation: Blurred Vision, Flashes, and Floaters

A 40-year-old black man reports progressively blurry vision with flashes and floaters for 2 years. He was evaluated a year earlier for a neck mass. He was told that it was "not cancer" and that he should follow up with a dentist, but he did not see a dentist at that time.

He takes no medications and denies smoking, drinking, and drug use.

Clinical Evaluation

Examination and testing of the patient revealed the following:

  • Best corrected vision: 20/200 in each eye without pinhole improvement

  • Pupils equal and reactive to light without afferent defect

  • External examination: large, multilobulated, firm, nontender, right-side neck mass (Figure 1)

  • Anterior segment examination: unremarkable

  • Intraocular pressure: normal

  • Dilated fundus examination: optic atrophy bilaterally, with 1+ vitritis, a large area of atrophic, placoid maculopathy with retinal pigment epithelium hyperplasia, and punctate choroiditis throughout the posterior pole in both eyes (Figures 2 and 3)

Figure 1. Multilobulated, firm, nontender facial mass.

Figures 2 and 3. Right and left eye showing placoid maculopathy and punctate choroiditis with vitritis. Optic atrophy is also present.