Case Studies in Ophthalmology
Cases for the Ophthalmology Clerkship
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Case #25 Presumed Ocular Histoplasmosis Syndrome
History
A 36 year old man from Iowa presents to your office with a four day history of decreased vision and distortion of vision in the left eye. Fundus photos from the left eye are shown in Photos 1 and 2.
Photo #1: Fundus photo, left eye
Photo #2: Fundus photo, left eye
Photo #3: A fluorescein angiogram of the left eye.
Photo #4: The fundus following laser treatment
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Question #1
What does the peripheral retina in Figure 1 show? What is the lesion in the macula of the left eye shown in Figure 2?
Question #2
What is the pathogenesis of this lesion?
Question #3
Of what importance is it that this gentleman is from Iowa?
Question #4
Is this an infection and can this disease be transferred from this man to another patient?
Question #5
What is the natural history of this lesion and is there any effective treatment?
Question #6
What is the risk of this disease occurring in the fellow eye?
References 25
Schlaegel TF Jr: Presumed Ocular Histoplasmosis (In): Duane, TD, Clinical Ophthalmology, Chpt 48 1987.
The Macular Photocoagulation Study Group: Argon Laser Photocoagulation for ocular histoplasmosis: Results of a randomized clinical trail. Arch Ophthalmol 1983; 101:1347-1357.
The Macular Photocoagulation Study Group: Krypton laser photocoagulation for neovascular lesions of ocular histoplasmosis: Results of a randomized clinical trial. Arch Ophthalmol 1987; 105:1499-1507.