Visual Disturbances in a Young Adult with Suspected Autoimmune Disease

Case at a Glance

A 19-year-old male presenting with chronic visual symptoms including retro-orbital pain, floaters, photopsia, and color desaturation in the right eye, with bilateral posterior vitreous detachment found on ultrasound despite no apparent risk factors.

Patient's Story

The patient reports a several-month history of fluctuating visual symptoms that significantly impact his daily activities. His primary complaints include persistent pain behind both eyes, visual floaters visible even in dim lighting conditions, flashing lights (photopsia), reduced color saturation specifically in the right eye, and intermittent episodes of slow focusing and blurred vision in the same eye. While symptom severity varies, complete resolution never occurs. The patient notes particular concern about the chronic nature of these symptoms and their impact on his quality of life.

Initial Assessment

The patient was initially evaluated by both ophthalmology and rheumatology services. Ophthalmological examination findings were reported as within normal limits by the treating physician, who attributed symptoms to psychosomatic causes. However, ocular ultrasound revealed bilateral posterior vitreous detachment with mobile vitreous opacities. Rheumatological evaluation raised suspicion for an underlying autoinflammatory condition, though specific details of this assessment were not provided.

The Diagnostic Journey

The case presents several diagnostic challenges. The finding of bilateral posterior vitreous detachment in a young patient without typical risk factors (no myopia, no ocular trauma history, young age) is unusual and warrants further investigation. The discrepancy between the patient's symptomatic presentation and the ophthalmologist's normal examination findings suggests either subtle pathology not initially detected or the need for more specialized evaluation. The rheumatologist's suspicion of autoinflammatory disease adds another dimension requiring correlation with ocular findings.

Final Diagnosis

Pending - requires further specialist evaluation. Differential diagnoses include: 1) Inflammatory vitreoretinopathy associated with systemic autoinflammatory condition, 2) Idiopathic bilateral posterior vitreous detachment, 3) Early uveitis with minimal clinical signs, 4) Vitreous inflammation secondary to systemic inflammatory process.

Treatment Plan

Second ophthalmological opinion recommended, preferably with a vitreoretinal specialist or uveitis specialist given the systemic inflammatory concerns. Comprehensive inflammatory workup coordination between rheumatology and ophthalmology services. Consider advanced imaging including optical coherence tomography and fluorescein angiography to evaluate for subtle inflammatory changes. Serial examinations to monitor progression of symptoms and vitreous changes.

Outcome and Follow-up

Patient awaiting specialized consultation due to geographic and financial constraints. Temporary management includes symptom monitoring and patient education about warning signs requiring urgent evaluation (sudden vision loss, severe pain increase, new symptoms). Coordination of care between rheumatology and ophthalmology planned for comprehensive evaluation of potential systemic-ocular inflammatory connection.