Case
A 73 year old female presents with a history of waking with
visual blurring in the left eye three days earlier. Although it has improved mildly since then, she still
complains of seeing poorly from the eye.
There is no history of eye pain, flashes, or floaters and she reports no
problems with the right eye. Her
past medical history is significant for hypertension, hypothyroidism, and
osteoporosis while her past ocular history is unremarkable.
On examination, best-corrected visual acuity is 20/20 and
20/80 in the right and left eyes, respectively. Anterior segment exam is normal. Posterior segment exam of the left eye is shown below:
What is the most likely diagnosis?
1.
Diabetic retinopathy
INCORRECT- Although
proliferative diabetic retinopathy is a common source of vitreous hemorrhage,
there is no known history of diabetes in the patient, and nor is there signs of
diabetic retinopathy present.
2.
Age-related macular degeneration
INCORRECT- Neovascular
age-related macular degeneration can occasionally
cause a vitreous hemorrhage. However,
this eccentrically located lesion is not typical of ARMD.
3.
Posterior vitreous detachment
Posterior vitreous
detachment is an age-related shrinkage of the vitreous humour that can often
cause vitreous hemorrhage when associated with a retinal tear or avulsion of a
small papillary vessel. The
absence of preceding symptoms of flashes/floaters, as well as the retinal
appearance in the fundus photo make this less likely.
4.
Retinal arterial macroaneurysm
CORRECT