Rod Foroozan, MD

Disclosures

December 19, 2014

Case Diagnosis

Automated perimetry showed nasal defects on each side on 10-2 testing. There was thinning of the outer retina on OCT. These findings suggest a retinopathy, and the pattern is consistent with retinopathy associated with hydroxychloroquine.

There was little to suggest an optic neuropathy. Pupils, color vision, and optic disc appearance were all normal. There were no ocular findings suggesting that active SLE was producing an ocular abnormality.

Although growth of the pituitary adenoma could compress the optic chiasm, chiasmal compression causes preferential involvement of the temporal visual field. This patient's visual field defects were nasal.

Occipital stroke would be expected to cause homonymous visual field loss rather than binasal defects.

Clinical Course

The nasal defects associated with thinning of the outer retina on OCT suggest retinopathy, and the pattern is consistent with hydroxychloroquine retinopathy. The patient was told not to restart hydroxychloroquine. An appointment with her rheumatologist to evaluate further therapy should be considered.

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