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 33-year-old man with no past medical history presented with a 3-day history of blurred vision and intense photophobia in the LE 3 weeks after the onset of mild chikenpox. On examination, BCVA was 20/20 in the RE and 20/30 in the LE. Slit-lamp examination of the LE showed perilimbal injection, fine keratic precipitates, and 2+ cells with 1+ flare in the anterior chamber. Intraocular pressure was 16 mmHg. There was no vitritis, and dilated fundus findings were normal. Examination results of the RE were normal. A diagnosis of unilateral acute non-granulomatous anterior uveitis secondary to varicella was made. The patient was treated by topical dexamethasone six times a day and cycloplegic agent twice daily. The uveitis resolved within 2 weeks, and visual acuity improved to 20/20 in the LE. No recurrence of uveitis was observed over a follow-up of 12 months.