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Bilateral uveal effusions in a 23-year-old man
Digital Journal of Ophthalmology 2018
Volume 24, Number 2
May 22, 2018
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Karen W. Jeng-Miller, MD, MPH | Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
Eric D. Gaier, MD, PhD | Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
Angela V. Turalba, MD | Department of Ophthalmology, Atrius Health, Boston, Massachusetts
Differential Diagnosis
Bilateral angle closure secondary to uveal effusions can have multiple causes, including pharmacologic, inflammatory, neoplastic, vascular, and idiopathic mechanisms. Assessment for inflammatory and neoplastic etiologies is paramount in order to begin prompt and appropriate treatment. Structural etiologies, such as nanophthalmos, should also be investigated in order to prevent further unnecessary testing.(1) A thorough review of systems should be conducted, especially with regard to any recent new pharmacological intake. A commonly implicated pharmacologic agent resulting in uveal effusions is topiramate. Inflammatory conditions that can cause uveal effusions include posterior scleritis, Vogt-Koyanagi-Harada disease, and choroiditis. Despite the patient’s young age, it was deemed prudent to consider neoplastic causes, such as choroidal melanoma or ocular metastases. Hypertension, especially pulmonary hypertension, can also cause bilateral uveal effusions. Nanophthalmos can lead to spontaneous choroidal effusions and retinal detachments, albeit rarely. Lastly, uveal effusion syndrome, an idiopathic process, is a consideration of exclusion. It is important to understand the rarity of simultaneous bilateral primary angle closure and that the presence of bilateral angle closure should prompt investigation into secondary causes.
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