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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Retina

Case 16

Patient Presentation: A 70-year-old male presented with blurry vision in both eyes for the past three weeks. He had a history of chronic lymphocytic leukemia (CLL), hypertension, schizophrenia, benign prostatic hyperplasia, and dyslipidemia. He was currently taking Imbruvica (medication for CLL), ramipril, chlorpromazine, tamsulosin, and rosuvastatin. On examination, visual acuity was 20/30 in both eyes. Slit lamp examination was normal. Fundus examination demonstrated abnormalities in the macula. An OCT macula was performed demonstrating the following:

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Question: Please describe the OCTs above?

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Question: What medication is the likely cause for the changes seen on OCT?

B. Chlorpromazine

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Question: Which of the following medications has NOT been reported to cause cystoid macular edema?

A. Prostaglandin analogues

Learning Objectives:

1. Drug-induced cystoid macular edema can occur and should be on the differential when assessing a patient for macular edema.

2. CME is characterized by intra-retinal fluid in the outer plexiform layer and the inner retinal layers (inner nuclear and plexiform)

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