A 65-year-old man presented to the emergency department with a 3-day history of decreased vision in his right eye associated with redness, pain, photophobia, and increased floaters. Over the past few days he felt his symptoms were getting worse. He was otherwise healthy with no significant ocular history. He denied any history of immunosuppression. He was monogamous and denied any history of sexually transmitted diseases. Of note, he had a remote history of V1 shingles eight years ago.
On examination his visual acuity was 20/100 (right eye) and 20/20 (left eye). There was no improvement with the use of a pinhole occluder. There was no relative afferent defect on examination. Intraocular pressures were 8 and 16 mm of Hg by Tonopen respectively. Slit lamp examination of the right eye demonstrated 3+ injection, 2+ chemosis, 2+ anterior chamber cell, 2+ flare, large keratic precipitates clustered inferiorly and centrally on the endothelium (Arlt’s Triangle), a normal iris, and 1+ nuclear sclerosis. Slit lamp examination of the left eye demonstrated 1+ nuclear sclerosis. Dilated fundus examination of the right eye revealed grade 2 vitreous haze, 4+ cell, a partially swollen and numerous yellowish pale areas of retinal. In addition, peri-vascular retinal hemorrhages. Dilated fundus examination of the left eye was within normal limits.