Josh Uhr, MD, Matthew Palmer, MD, PhD, and James P. Dunn, MD
Published 14 October 2018
October 2018 Wills Eye Resident Case Series
A 23-year-old woman presents to the Wills Eye Emergency Room complaining of bilateral eye pain and redness.
A 23-year-old Caucasian female presented to the Wills Eye Emergency Room complaining of two days of bilateral eye pain, photophobia and redness. There was no change in vision. She had not had similar symptoms previously.
The patient had no past ocular history. Past medical history was significant for a hospital admission two months prior to presentation for a week of weakness, nausea and vomiting. She was found to have an increased creatinine of 2.84 and granular casts on urinalysis, consistent with acute tubular necrosis. The creatinine increased to 4.00, and a kidney biopsy was performed showing tubular interstitial nephritis with eosinophilia. Medications at the time of admission included calcium carbonate, lactobacillus probiotic, acetaminophen as needed, the weight-loss supplement Apidexin, a multivitamin and over-the-counter nasal decongestants; none were considered to be the cause of the interstitial nephritis. The patient was started on prednisone 60 mg daily, which was quickly tapered over the following month. Family history was negative for renal or autoimmune diseases. Social history was non-contributory.
Examination Ophthalmic examination revealed a visual acuity of 20/20-2 in the right eye and 20/20 in the left. Pupils were normal and intraocular pressures were 12 mmHg in both eyes. Motility and confrontational visual fields were full bilaterally.
The anterior segment examination revealed 1+ conjunctival injection with ciliary flush in both eyes. Diffuse fine keratic precipitates and 2-3+ cell and flare were observed in each eye. Pigment on the anterior capsule was also noted. Dilated fundus exam was normal without vitritis, chorioretinitis, macular or optic disc edema, or vessel sheathing in either eye.