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15-year-old was seen in the office on 1-31-08. She was doing fine until about a year ago. She had pink eye. She was using a face cloth, which was beaded. She got some of the beads in her eye. Her eye was irritated. Since then her vision has been abnormal. She recently went for a drivers’ test and failed, and came to see you because of the need for an eye exam. You noticed a problem with the right eye and suggested she come in here for evaluation. She was sick about two years ago, and she was diagnosed at that time with mononucleosis. Other than that, she denies any rashes, fevers, coughs, joint pains, sores oral or genital, and she feels good now. VISUAL ACUITY: OD: 20/80; OS: 20/20. IOP: OU: 17. Slit Lam Exam: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. There are trace vitreous cells. There is a white fibrous subretinal lesion on the superior pole of the optic nerve a disc diameter across, and elevated at the edges of that there are pigment irregularities. There is a pigment streak going through the macula, which touches the fovea. The pigment epithelium looks irregular predominantly superiorly. There is no active retinitis, vasculitis or uveitis. OS: Vertical C/D ratio is 0.0. There is no posterior vitreous separation. The macula and periphery look healthy. A fluorescein angiogram shows minimal hyperfluorescence in the superior periphery. Under the macula there is a linear area of hyperfluorescence where there is a pigment epithelial irregularity and the white spot is mostly hypofluorescent because it is avascular. The left angiogram was normal. IMPRESSION: 1. PROBABLE TOXOCARIASIS IN THE RIGHT EYE. DISCUSSION: I explained to the patient that the white lesion on the optic nerve looks like it is probably a granuloma from an infection with toxocariasis. Usually it is Toxocara canis, but it can be Toxocara cadis. Either way, at this point there is no active inflammation in the eye. Other things that can cause unilateral vision problems in the younger population include diffuse unilateral sub-neuroretinitis. These white granulomas could be seen in diseases such as sarcoidosis or tuberculosis. In general, uveitis can be seen in anybody with several other possible diseases. Since this looks so much like toxocariasis, I am going to check her toxocara titres and also a blood count and a comprehensive metabolic panel to rule out any other blood disgrasias or specially check her liver functions. I asked her to return here for a check in two to three months, sooner should she notice any problems. I suspect the vision in this eye will remain limited, but stable. It would be reasonable to consider putting her in protective glasses, mostly to protect her left eye. I asked her to discuss that with you. I asked her to return urgently should she notice any problem, and also to find a pediatrician in the area. She recently moved here from Tallahassee. Once she finds someone, I will forward all of the blood tests I receive to that doctor for evaluation. NOTE: patient never followed up with any recommendations.

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Toxocariasis262 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 55555
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Toxocariasis186 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis216 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis294 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis312 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis168 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis142 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis156 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis128 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis231 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis205 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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Toxocariasis333 views15-year-old one year ago had pink eye then her vision has been abnormal. She recently went for a drivers’ test and failed, OD: 20/80; OS: 20/20. 00000
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15-year-old was seen in the office on 1-31-08. She was doing fine until about a year ago. She had pink eye. She was using a face cloth, which was beaded. She got some of the beads in her eye. Her eye was irritated. Since then her vision has been abnormal. She recently went for a drivers’ test and failed, and came to see you because of the need for an eye exam. You noticed a problem with the right eye and suggested she come in here for evaluation. She was sick about two years ago, and she was diagnosed at that time with mononucleosis. Other than that, she denies any rashes, fevers, coughs, joint pains, sores oral or genital, and she feels good now. VISUAL ACUITY: OD: 20/80; OS: 20/20. IOP: OU: 17. Slit Lam Exam: Normal with clear lenses. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.0. There are trace vitreous cells. There is a white fibrous subretinal lesion on the superior pole of the optic nerve a disc diameter across, and elevated at the edges of that there are pigment irregularities. There is a pigment streak going through the macula, which touches the fovea. The pigment epithelium looks irregular predominantly superiorly. There is no active retinitis, vasculitis or uveitis. OS: Vertical C/D ratio is 0.0. There is no posterior vitreous separation. The macula and periphery look healthy. A fluorescein angiogram shows minimal hyperfluorescence in the superior periphery. Under the macula there is a linear area of hyperfluorescence where there is a pigment epithelial irregularity and the white spot is mostly hypofluorescent because it is avascular. The left angiogram was normal. IMPRESSION: 1. PROBABLE TOXOCARIASIS IN THE RIGHT EYE. DISCUSSION: I explained to the patient that the white lesion on the optic nerve looks like it is probably a granuloma from an infection with toxocariasis. Usually it is Toxocara canis, but it can be Toxocara cadis. Either way, at this point there is no active inflammation in the eye. Other things that can cause unilateral vision problems in the younger population include diffuse unilateral sub-neuroretinitis. These white granulomas could be seen in diseases such as sarcoidosis or tuberculosis. In general, uveitis can be seen in anybody with several other possible diseases. Since this looks so much like toxocariasis, I am going to check her toxocara titres and also a blood count and a comprehensive metabolic panel to rule out any other blood disgrasias or specially check her liver functions. I asked her to return here for a check in two to three months, sooner should she notice any problems. I suspect the vision in this eye will remain limited, but stable. It would be reasonable to consider putting her in protective glasses, mostly to protect her left eye. I asked her to discuss that with you. I asked her to return urgently should she notice any problem, and also to find a pediatrician in the area. She recently moved here from Tallahassee. Once she finds someone, I will forward all of the blood tests I receive to that doctor for evaluation. NOTE: patient never followed up with any recommendations.