A 68-year-old man presented to the emergency department of his local hospital with sudden painless vision loss in the right eye. He denied any eye trauma, light flashes or floaters. On examination, he was found to have hand-motion vision, and poor view on dilated fundoscopic exam due to a dense vitreous hemorrhage in the right eye. B-scan ultrasonography was performed and was interpreted as being consistent with the vitreous hemorrhage. On follow-up with a local retina specialist the following day he was noted to have subretinal elevation and subretinal fluid in the inferior fundus. He was referred to Wills Eye Hospital for further evaluation.
Past medical history was significant for hypertension, hyperlipidemia and non-insulin-dependent diabetes mellitus. His ocular history included refractive error and the suspicion of glaucoma (he had a family history of glaucoma). He denied using alcohol, tobacco or illicit drugs and didn’t have any known drug allergies. His medication list included latanoprost, aspirin, metformin/sitagliptin, quinapril, tamsulosin, hydrochlorothiazide, nebivolol, atorvastatin and amlodipine.
Ocular examination demonstrated visual acuity of hand motion in the right eye and 20/30 in the left eye. Both pupils were round, reactive and showed no afferent pupillary defect. Intraocular pressures were 11 and 10 mmHg in the right and left eyes, respectively. Extraocular motility was full bilaterally, and there was no proptosis. Anterior segment examination revealed trace injection, prominent inferior conjunctival vessels, a small iris nevus in the right eye and mild nuclear sclerosis OU. There was no view on dilated fundoscopic examination of the right eye due to extensive vitreous hemorrhage. Fundoscopic examination of the left eye revealed peripapillary atrophy, optic disc cupping with a cup/disc ratio of 0.4, two small choroidal nevi each measuring 2 mm in diameter, peripheral retinal pigment epithelial alterations and no evidence of diabetic retinopathy, macular degeneration or lattice degeneration.
What is your diagnosis? What further workup would you pursue? Please click this link for diagnosis, workup, treatment and discussion.