Why Is This Woman Seeing Spots?

Clinical Presentation

A 65-year-old woman has experienced "spots" in the vision of both eyes for the past 2 months, and the problem has been stable. She has a medical history of systemic lupus erythematosus (SLE) and hypertension. She had cataract surgery in each eye 5 years ago. She had neurosurgery for a pituitary adenoma 6 years before presentation, and her most recent MRI of the brain 2 years before presentation showed a persistent sellar/suprasellar-based mass 7 mm in its largest diameter. An erythrocyte sedimentation rate was 5 mm/h.

Her current medications include lisinopril and methotrexate. She takes prednisone intermittently and was taking hydroxychloroquine 200 mg twice daily for 10 years, but she had stopped this medication 3 months before presentation. The patient does not drink alcohol or smoke tobacco. There is no family history of visual loss.

Eye Evaluation

The eye examination and testing indicated the following:

• Visual acuity: 20/20 in both eyes without correction.

• Color vision with Ishihara pseudoisochromatic plates: 10/10 in both eyes.

• Pupils were brisk with no relative afferent pupillary defect.

• Automated perimetry showed a few points of reduced sensitivity in each eye (Figure 1).

• Intraocular pressure: 19 mm Hg in each eye.

• Slit lamp examination of the anterior segment showed posterior chamber intraocular lenses on each side.

Optical coherence tomography (OCT) of the macula was also done (Figure 2).

Figure 1. Automated perimetry showing reduced sensitivity in the left and right eye.

Figure 2. OCT, right eye (top) and left eye (bottom).

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Cite this: Why Is This Woman Seeing Spots? - Medscape - Dec 19, 2014.