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Acute Macular Neuroretinopathy A young patient presents with acute onset of blurry vision and scotoma. Visual acuity is 20/25 in both eyes. Exam reveals hypopigmented patches in the macula of both eyes, as well as a flame hemorrhage in the left. Imaging reveals disruption of the outer plexiform, ou…

Acute Zonal Occult Outer Retinopathy (AZOOR) A patient with a history of photopsias in the left eye for approximately 20 years comes for evaluation due to photopsias now involving both eyes. Concomitantly, the patient also notices scotomas in both eyes. Infectious, immune, and degenerative retinopa…

Bardet-Biedl Syndrome A young adult presented with progressive decrease in the visual acuity of both eyes. Past medical history included idiopathic intracranial hypertension suspect, obesity, learning disabilities, anxiety, polydactyly (status post excision of an extra toe). Family history includes…

Marfan Syndrome with Ectopia Lentis A young child presented to the ophthalmology clinic with blurry vision. Slit lamp examination was notable for superotemporally subluxed lenses in both eyes, along with a tall slender body frame. Due to these findings, the patient was referred to a geneticist and …

Nontuberculous Mycobacteria Keratitis A patient five months after bilateral simultaneous cataract surgery in another country presents to the BPEI emergency room with bilateral decreased vision and extreme right eye pain for the last 2 weeks. Their exam was notable for visual acuity of hand motion i…

A young patient presented with a 1-week history of unilateral superior visual field deficit in the left eye with a visual acuity of 20/30 with pinhole correction to 20/20, normal IOP, and without an APD. Detailed medical, surgical, family, and social history-taking revealed only patient consumption…

Central Retinal Artery Occlusion An elderly patient presented to the BPEI Emergency Room 3 hours after onset of painless vision loss. Past medical history included hypertension and atrial fibrillation treated with apixaban, of which the patient reported good adherence. The patient had no other sign…

Choroidal Folds Related to Multiple Myeloma Recurrence A patient with a prior diagnosis of Fuchs endothelial dystrophy and a past medical history including renal amyloidosis previously treated with chemotherapy presented to the outpatient ophthalmology clinic for routine follow-up. Examination disc…

Non-Infectious Scleritis A monocular patient admitted for pyoderma gangrenosum flare complained of decreased vision and left eye pain. Four years prior she had scleritis OD which requiring scleral reinforcement surgery after which the patient was lost to follow up, developed endophthalmitis and eve…

Fundus photo of Central Retinal Artery Occlusion (CRAO).

Mixed Mechanism Angle Closure Glaucoma A patient presented with eye pain and decreased vision in the left eye and treated for HSV keratouveitis. A few months later, he presented with halos and high IOP. He was placed on topical glaucoma drops and continued to have episodes. A laser peripheral iride…

NUT Carcinoma A patient presented with several weeks of right eye proptosis. On initial examination, his visual acuity in the right eye was 20/400, and a relative afferent pupillary defect was noted. He had 4 mm relative proptosis on the right and restricted motility in all gaze directions. CT orbi…

Pseudophakic Bullous Keratopathy with Prior Descemet Membrane Tears due to Forceps Trauma A patient with a history of forceps trauma at birth and amblyopia of the left eye who presents with persistent corneal edema 1 year after uncomplicated cataract surgery. Initial visual acuity was 20/200, intra…

Slit lamp photos of non-infectious necrotizing scleritis at presentation, week 4, 7, 9.5, and 12 of treatment with systemic corticosteroids and rituximab.

Metastatic Melanoma; Side effect of Immune Checkpoint Inhibitor A patient with a history of recurrent metastatic conjunctival melanoma presented with a left upper lid orbital lesion and pigmented lesion in the medial fornix. The original conjunctival melanoma was originally excised in an outside ce…

Bilateral Diffuse Uveal Melanocytic Proliferation A patient with a past medical history of bladder and lung cancer s/p primary excisional therapy, chemotherapy, and a short course of immunotherapy presented with a recent episode of blurry vision in both eyes. Patient’s exam was notable for visual…

Exudative Age-Related Macular Degeneration A patient with neovascular age-related macular degeneration in both eyes has been receiving intravitreal aflibercept in her left eye every 4-5 weeks, for more than 10 years. Whenever the interval between the intravitreal injections was increased there was …