Case Report: Recurrent Acute Macular Neuroretinopathy-Monitoring Recovery with Multimodal Imaging.

SIGNIFICANCE: Acute macular neuroretinopathy (AMN) is a rare, nonprogressive condition affecting the outer retina that can be diagnosed clinically using widely available multimodal imaging techniques. This case report presents an exceedingly rare same-eye recurrence of AMN and describes the characteristic imaging findings of this unique, not fully understood clinical entity. PURPOSE: The following report provides a detailed account of recurrent AMN from 4 hours of symptom onset to 4 months with repeat multimodal imaging captured at different visits. This report also devotes some discussion to the current understanding of its pathophysiology, associations, management, and imaging characteristics. CASE REPORT: A 32-year-old woman with unilateral recurrent AMN was monitored frequently with various multimodal imaging from 4 hours after onset of new scotoma to 4 months. The primary finding in the acute stage was a hyperreflective lesion of the outer nuclear and outer plexiform layers followed by disruption of underlying external limiting membrane, ellipsoid zone, and photoreceptors. This resolved into stable outer nuclear layer thinning and subtle disruption of the deeper layers after 1 week. Fundus photography revealed a red-brown petaloid lesion adjacent to the fovea, and optical coherence tomography angiography revealed subtle decreased perfusion of the choriocapillaris layer throughout follow-up. CONCLUSIONS: Acute macular neuroretinopathy is a rare nonprogressive condition of the outer retina most often affecting otherwise healthy young female individuals and is most associated with recent flu-like illness and oral contraceptives. The underlying mechanism of AMN remains unknown, but modern imaging techniques have elucidated the disease locus to be choroidal and/or deep capillary plexus. It is important for eye care providers to recognize AMN as a clinical entity distinct from other retinal conditions that require different management.

Case Report: An Isolated Abducens Palsy Secondary to Lyme Disease.

SIGNIFICANCE: Lyme disease can have widespread and long-lasting systemic implications, and ocular manifestations of Lyme disease may be the only presenting symptoms of infection. As such, eye care providers can play a critical role in facilitating the diagnosis and treatment of this disease. PURPOSE: This case report describes an isolated sixth nerve palsy secondary to Lyme disease, which is a rare neuro-ophthalmic presentation. This report emphasizes the importance of considering Lyme disease in the setting of atypical nerve palsies to allow for appropriate treatment and prevent long-term complications of untreated disease. CASE REPORT: A 63-year-old man presented with new-onset, painful diplopia for 1 day and was diagnosed with a right sixth nerve palsy. His medical history was significant for relapsing polychondritis with associated ocular complications, so his nerve palsy was presumed secondary to a flare of his systemic disease. However, secondary to complaints of new night sweats, infectious etiologies were also considered. The patient was initially treated with oral steroids with no improvement in his diplopia after being admitted to the hospital for further workup. Approximately 1 week after presentation, Lyme titers returned positive, and the diagnosis was revised to abducens palsy secondary to Lyme disease. The patient's nerve palsy rapidly resolved after oral therapy with doxycycline. CONCLUSIONS: Lyme disease is a systemic illness that can have widely varying manifestations, including ocular findings. Eye involvement may be the only presenting symptom, allowing eye care providers to serve an important role in disease recognition and management.