A 62-Year-Old Man With Pain and Photophobia

Kimberly K. Reed, OD; Case Series Editor: Jean Marie Pagani, OD

Disclosures

August 16, 2013

Clinical Presentation

A 62-year-old man presented with complaints of severe pain, photophobia, and redness in his left eye for 2 weeks. At the initial appearance of symptoms, he had also noted white discharge in his eye. At that time, he sought care from his primary care provider, who prescribed ciprofloxacin eye drops. The patient reported that the discharge disappeared after 4 days of using the eye drops but that the pain and photophobia had intensified since then. In addition, he noticed reduced vision. The patient stated that this is the first episode he has experienced with these symptoms. Medical history was significant for hypercholesterolemia and a heart valve replacement. The patient reported an allergy to penicillin and was taking simvastatin and aspirin.

Best-corrected visual acuity was 20/20 in the right eye (OD) and 20/40 in the left eye (OS). Pupils were round and reactive, but a slight anisocoria was noted in the dark only (7 mm OD, 6 mm OS). Slit-lamp examination revealed diffuse injection in both eyes but greater severity in the left eye than the right (Figure 1). Both corneas showed keratic precipitates (Figure 2 and Figure 3), and both anterior chambers showed cells and flare, although they were much more pronounced in the left eye than in the right. No follicles or papillae were detected in either eye. Anterior chamber angles were open to scleral spur in all quadrants in both eyes. Intraocular pressures (IOPs) were 35 mm Hg OD and 31 mm Hg OS. Dilated fundus examination revealed cup-to-disc ratios of 0.25 x 0.25 OD and 0.35 x 0.35 OS. The remainder of the posterior segment evaluation was unremarkable in both eyes.

Figure 1. Photograph showing diffuse injection of the conjunctiva.

Figure 2. Slit-lamp examination revealed keratic precipitates (indicated by arrow).

Figure 3. Slit-lamp examination revealed keratic precipitates.

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