Patient experiences vision loss in Indonesia

A previously healthy 19-year-old college student was referred to the New England Eye Center for evaluation after returning from Indonesia where she had studied abroad and suffered a severe illness requiring hospitalization. She had blurred vision in both eyes, photophobia and a blind spot in the center of her vision. Her ocular history was notable only for congenital coloboma in her right eye, and she was on no medications. She had never smoked cigarettes or used drugs, and she drank beer and liquor occasionally with friends.On presentation, visual acuity was 20/30-1 in the right eye and 20/15-1 in the left eye. The right pupil was irregular, but both pupils were reactive and there was no afferent defect. The patient recognized all Ishihara color plates with both eyes. She had saccadic pursuit movement, but saccades were accurate and vestibulo-ocular responses appeared normal. There was an inferonasal iris coloboma and an inferior chorioretinal defect with a tilted optic disc associated with mild peripapillary atrophy (Figure 1a). In the left eye there was trace segmental pallor of the optic disc temporally (Figure 1b).