A 39-year-old woman with rheumatoid arthritis, sleep apnea and a body mass index of 55 presented with nausea, vomiting and floaters in the right eye for two days. Two weeks prior, she developed positional headaches, blurry vision and transient visual obscurations. On presentation, her best corrected visual acuity was 20/25 in each eye, there was no relative afferent pupillary defect and the examination of external structures and anterior segment was unremarkable.\nFunduscopic examination revealed Frisen grade 4 papilledema in the right eye with vitreous, subretinal and intraretinal hemorrhages, and grade 3 in the left eye with flame-shaped hemorrhages (A, ).\nHead CT with contrast appeared normal, an MRI was not possible due to body habitus and weight restrictions. Lumbar puncture under fluoroscopic guidance revealed opening pressure of 310 mm CSF with normal composition. Humphrey visual field 24-2 SITA Fast was reliable with an enlarged blind spot and a few central changes in the right eye (mean deviation −4.00 dB) and was essentially full with mild central depression in the left eye (mean deviation −3.55 dB).\nShe was started on acetazolamide 500 mg twice daily, which was titrated up to 1500 mg twice daily with gradual resolution of symptoms over a month. At two month follow up, the vitreous hemorrhage had resolved and there was marked improvement in the papilledema bilaterally ( C, D).
A 40-year-old otherwise healthy woman noticed pain, redness, watering, photophobia, and decreased vision in both eyes one week after the onset of severe chickenpox. On examination, BCVA was counting fingers in the RE and 20/200 in the LE. Slit-lamp examination showed perilimbal injection and a geographic corneal epithelial defect associated with diffuse stromal edema in both eyes (Fig. ). The anterior chamber was deep and quiet, and there were no vitritis or abnormal fundus findings.\nA diagnosis of varicella keratitis was made. The patient was treated with systemic acyclovir (30 mg/kg/day). Oral steroids (0.5 mg/kg/day) were added 6 days after antiviral treatment, because of the severe associated stromal edema. The corneal defect resolved slowly within 2 weeks, and the medication was discontinued.\nThree months later, the patient presented with complaints of decreased vision and eye pain bilaterally. On examination, BCVA was 20/35 in both eyes. Slit-lamp examination showed perilimbal injection, many small raised dendriform lesions, and marginal infiltrates in the cornea of both eyes. A diagnosis of recurrent varicella keratitis was made, and the patient was once again treated with systemic acyclovir (30 mg/kg/day) and oral steroids (0.5 mg/kg/day) 4 days later. Corneal lesions resolved within 2 weeks with residual peripheral corneal scars (Fig. ), and visual acuity improved to 20/25 in both eyes. No recurrence of keratitis was observed after 18 months of follow-up.