A 19-year-old man presented with floaters and vision loss in his left eye over the past year. On examination, he had cells in his anterior chamber, vitreous hemorrhage, a swollen optic disc, cystoid macular edema, subretinal fibrosis, and chorioretinal scars in his left eye. Investigations did not reveal an infectious cause. He was treated with orbital floor triamcinolone injections which improved his cystoid macular edema but caused steroid-induced glaucoma, requiring glaucoma medication. His inflammation later flared up again requiring additional steroid treatment.

1. Posterior uveitis
By
HANY EL-DEFRAWY

2. • 19 year old Caucasian man complained of
seeing floaters for 13 months in left eye.
• Painless deterioration of vision for 10
months in left eye.
• No history of fever , weight loss, chronic
cough, joint pains, skin rash, mouth ulcers
• No history of TB contact
• No history of animal contact

3. • BCVA 6/4, 6/60
• Anterior segment +1 cells
• Fundus: Slight vitreous hemorrhage in left eye
• Swollen optic disc.
• Cystoid macular edema.
• Subretinal fibrosis
• Multifocal chorioretinal scars
• Shallow exudative RD
• ERM

7. Investigations
• FBC
• ESR
• Syphilis
• LFT, U and E, Coagulation, ACE
• U/S liver: echogenic lesion
• Serology: Toxocara,
Cysticercosis,Leishmaniasis,Lyme disease
HBSAg, Filariasis, Hydatid
• Infectious mononucleosis screen negative.

8. Management
• Orbital floor triamcinolone 40 mg

9. • CMO responded very well
• Patient developed steroid response
glaucoma
• Alphagan and cosopt BD was prescribed
for the left eye.

10. • Flare up of inflammation, AC cells +2, Bio
score 2, swollen hyperaemic optic disc,
• Had orbital floor triamcinolone.

11. parasitic eye disease
• Zoonatic diseases
• Contact with infected animals
• Consumption of raw meat

12. • Toxoplasmosis (Acquired, congenital).
• Toxocariasis (T Canis).
• DUSN (Baylisascaris procyonis)
• Onchocerciasis (Onchocerca volvulus)
• Cysticercosis (Cysticercus cellulosae)
• Ophthalmomysis
• Echinococcosis (Echinococcosis)
• Amebiasis