A 26-year-old African American female presented to the Bascom Palmer Eye Institute emergency room with complaints of progressively decreasing vision in both eyes over the past 2 weeks associated with numbness on the right side of her face and mouth. She also had symptoms of light sensitivity but denied flashes, floaters, or other ocular symptoms. She denied any other recent illnesses, drug usage, exposure to parasites, infections, or risk factors for HIV.
Fundoscopic exam of both eyes (Figure 1) was significant for normal-appearing optic discs with normal borders and no evidence of papilledema. Multiple cotton-wool lesions surrounded the optic discs of both eyes, with infiltration of the fovea on the left. The lesions were flat and located within the retinal nerve fiber layer.
The differential diagnosis includes retinal vasculitis, hypertensive retinopathy, giant cell arteritis, Purtscher's retinopathy, optic neuritis, HIV retinopathy, sarcoidosis, syphilitic chorioretinopathy, and tuberculosis.