46-year-old man was seen in the office on October 3, 2011. He has had blurred vision in the left eye for the last two years. He had cataract surgery in that eye eight years ago. He has also had a lot of floaters in the left eye for several years. His left eye is blue and his right eye is brown. As far as he knows that was since childhood. He remembers his mother talking about it. He doesn’t think it is a new finding. When he had the cataract surgery done eight years ago and no one mentioned the problem with inflammation in the eyes. He does have psoriasis and does have some joint pains and he has some disc problems. He had a workup for the psoriasis a long time ago. About ten years ago he had severe oral ulcers and flu-like symptoms. At that time you had extensive testing done, which didn’t really show anything specific. Recently he has traveled to both Italy and Costa Rica. VISUAL ACUITY: OD 20/16, OS 20/50. IOP: OD 13, OS 8. SLIT EXAMINATION: The right iris is brown. The eye is quiet. There is 2+ nuclear sclerosis. The left eye has fine keratic precipitates on the posterior surface of the cornea and 2+ cell and flare of the anterior chamber. The iris is blue. There is no posterior synechiae. The posterior chamber intraocular lens is in good position. There is 2+ deposits on the anterior surface of the lens as well as a 2+ posterior capsular opacity. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is 1+ macular drusen. OS: Vertical C/D ratio is 0.1. There is 2+ vitreous cell. The macula has a trace epiretinal membrane. There is no peripheral retinal lesions. There is no evidence of any retinal vasculitis. IMPRESSION: 1. INTERMEDIATE UVEITIS – LEFT EYE 2. POSTERIOR CAPSULAR OPACITY – LEFT EYE 3. POSSIBLE FUCH’S HETEROCHROMIC IRIDOCYCLITIS DISCUSSION: I explained to the patient given the history, I think he probably has Fuch’s heterochromic iridocyclitis. I asked him to try to find high school pictures and childhood pictures to see if at some point his eyes were the same color. At the moment his vision loss is probably a combination of the posterior capsular opacity and inflammation in the eyes. I started him on Pred Forte drops, which might help. I asked him to return for a check in four to six weeks or sooner should he notice a problem and see you back periodically. In the meantime I am going to obtain blood testing on him to rule out any sort of infectious etiologies and also looking for his HLA typing. He was given a medrol dose pack for his neck. Blood tests were all normal! |
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46-year-old man was seen in the office on October 3, 2011. He has had blurred vision in the left eye for the last two years. He had cataract surgery in that eye eight years ago. He has also had a lot of floaters in the left eye for several years. His left eye is blue and his right eye is brown. As far as he knows that was since childhood. He remembers his mother talking about it. He doesn’t think it is a new finding. When he had the cataract surgery done eight years ago and no one mentioned the problem with inflammation in the eyes. He does have psoriasis and does have some joint pains and he has some disc problems. He had a workup for the psoriasis a long time ago. About ten years ago he had severe oral ulcers and flu-like symptoms. At that time you had extensive testing done, which didn’t really show anything specific. Recently he has traveled to both Italy and Costa Rica. VISUAL ACUITY: OD 20/16, OS 20/50. IOP: OD 13, OS 8. SLIT EXAMINATION: The right iris is brown. The eye is quiet. There is 2+ nuclear sclerosis. The left eye has fine keratic precipitates on the posterior surface of the cornea and 2+ cell and flare of the anterior chamber. The iris is blue. There is no posterior synechiae. The posterior chamber intraocular lens is in good position. There is 2+ deposits on the anterior surface of the lens as well as a 2+ posterior capsular opacity. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is 1+ macular drusen. OS: Vertical C/D ratio is 0.1. There is 2+ vitreous cell. The macula has a trace epiretinal membrane. There is no peripheral retinal lesions. There is no evidence of any retinal vasculitis. IMPRESSION: 1. INTERMEDIATE UVEITIS – LEFT EYE 2. POSTERIOR CAPSULAR OPACITY – LEFT EYE 3. POSSIBLE FUCH’S HETEROCHROMIC IRIDOCYCLITIS DISCUSSION: I explained to the patient given the history, I think he probably has Fuch’s heterochromic iridocyclitis. I asked him to try to find high school pictures and childhood pictures to see if at some point his eyes were the same color. At the moment his vision loss is probably a combination of the posterior capsular opacity and inflammation in the eyes. I started him on Pred Forte drops, which might help. I asked him to return for a check in four to six weeks or sooner should he notice a problem and see you back periodically. In the meantime I am going to obtain blood testing on him to rule out any sort of infectious etiologies and also looking for his HLA typing. He was given a medrol dose pack for his neck. Blood tests were all normal!
