May 2025

OPHTHALMOLOGY

CASE REPORT: BILATERAL BLURRY VISION IN A 46-YEAR-OLD PATIENT

A 46-year-old male presented to Northwestern Medicine with one week of blurred vision in both eyes, as well as pressure around his eyes and a progressive headache with pulsatile quality. His past medical history was notable for prior photorefractive keratectomy, myopia and suspected glaucoma. His clinical exam demonstrated 20/50 visual acuity in both eyes, as well as findings consistent with panuveitis.
 
His dilated fundus exam was also notable for multiple pockets of subretinal fluid in and around the macula. 
​The patient was brought to the Ophthalmology Department for further imaging and evaluation by Northwestern Medicine uveitis specialists. Fluorescein angiography (FA) was significant for hyperfluorescent pockets of pooling coinciding with the areas of subretinal fluid that were visible on clinical exam. There was notably no disc leakage on FA. 
​Optical coherence tomography (OCT) exhibited multiple areas of bacillary detachments, subretinal fluid and choroidal infiltration bilaterally. With an absent trauma history and a work-up reassuring against other possible etiologies like tuberculosis-associated uveitis or sarcoidosis, the patient was diagnosed with Vogt-Koyanagi-Harada disease.
​The patient was started on topical and oral steroids, and the process was begun to initiate the patient on Humira®. In the following weeks, the patient endorsed new-onset muffled hearing and progressive tinnitus. The patient was subsequently admitted as an inpatient to receive high-dose IV steroids for three days and an otolaryngology consult. Formal audiology testing demonstrated left greater than right high-frequency sensorineural hearing loss. 
​Additional interventions to manage the patient’s condition included posterior sub-Tenon’s triamcinolone injections in each eye for treatment-resistant subretinal fluid. The patient was also able to receive insurance approval and start Humira during this time. At follow-up one month after his initial presentation, his visual acuity had improved to 20/20 in both eyes and his OCT demonstrated resolution of subretinal fluid and choroidal infiltration. 
Anjum Koreishi, MD, Assistant Professor of Ophthalmology at Northwestern Medicine 
John Bryan, MD, Ophthalmology Resident at Northwestern Medicine ​

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