A 44-year-old obese woman with a medical history of iron-deficiency anemia (pretreatment hemoglobin of 8.8 g/dL) presented with blurred vision in her right eye and new headaches over 1 month. She described the headaches as holocephalic, rated them 4–5 out of 10 (where 1 is minimal intensity and 10 is maximal intensity) without any diurnal or positional variation. She had associated intermittent nausea, but no vomiting. She denied any characteristics consistent with a thunderclap headache. She initially saw her optometrist and was referred to neuro-ophthalmology for bilateral optic disc edema. Examination revealed a visual acuity of 20/30 OD and 20/20 OS, and Humphrey visual field testing showed an enlarged blind spot OD (MD −4.60 dB) and was normal OS (MD −2.10 dB). Slit-lamp examination revealed a posterior subcapsular cataract in the OD and dilated fundus examination showed moderate optic disc edema in both eyes with hemorrhages in all 3 retinal layers in the OD (shown in Fig. ). Her blood pressure was 128/78, and her hemoglobin was found to be 9.0 g/dL with mean corpuscular volume of 70.4 fL. Magnetic resonance imaging/magnetic resonance venography of the head was normal apart from signs of raised ICP, and lumbar puncture showed an opening pressure of 34 cm of water with normal CSF contents. She was started on acetazolamide 500 mg BID and continued her recent supplementation with ferrous fumarate. With significant weight loss, her optic disc edema resolved after 4 months, and she continued to maintain normal visual function. The final Humphrey mean deviation was −2.80 dB OD and −0.72 dB OS.
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.