Ronald C. Gentile, MD; Chirag M. Shah, MPH

Disclosures

May 28, 2015

Clinical Presentation

A 50-year-old man suffered a corneal abrasion and traumatic iritis after a bungee cord injury 3 weeks ago, and received a tapering dose of topical corticosteroids. He had previously used topical fluoroquinolone antibiotics and cycloplegic drops for 2 weeks. His medical history was significant for myopia and glaucoma, and he was using a prostaglandin analog each night in both eyes.

The patient's visual acuity corrected to 20/20, with a -6:00 sphere in both eyes. Amsler grid testing was normal in both eyes, and confrontational visual fields revealed a slight reduction in inferior peripheral vision beyond 45° from fixation in the left eye. Color vision was normal using Ishihara plates in both eyes. Pupils were normal with no afferent pupillary defect. Intraocular pressures were 17 mm Hg in the right eye and 18 mm Hg in the left eye.

Anterior segment examination revealed clear lenses with peripheral posterior capsule pigmentation (Figures 1 and 2) and normal anterior chamber depths in both eyes. Fundus examination revealed a myopic fundus with peripapillary atrophy in both eyes (Figures 3 and 4), with a cup-to-disc ratio of 0.4 in the right eye and 0.6 in the left eye with sloping temporal rims. No posterior vitreous detachment was identified in either eye. The peripheral retina of the left eye revealed a superior retinal elevation (Figure 5).

Figure 1. Anterior segment slit-lamp photo of the temporal portion of the lens of the right eye, with linear pigment deposition at the equator.

Figure 2. Anterior segment slit-lamp photo of the temporal portion of the lens of the left eye, with linear pigment deposition at the equator.

Figure 3. Wide-field fundus photo of the right eye, with myopic tessellated fundus and peripapillary crescent. The peripheral linear shadow corresponds to findings on the slit-lamp photo.

Figure 4. Wide-field fundus photo of the left eye, with myopic tessellated fundus, peripapillary crescent, and superior retinal elevation. The peripheral linear shadow corresponds to findings on the slit-lamp photo.

Figure 5. Wide-field fundus photo of the left eye taken more peripherally than in Figure 4, showing the margins of the retinal elevation.

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