25 yr male with complaints of DOV in RE since 15 days.. he had intravit triamcinolone injected at some center in RE 12 days ago.. he also had DOV in LE since 8 days for which he had subtenon traimcinolone at a different hospital.. now he came to us with VA of 6/36 in RE and 6/9p in LE.. mantoux was weakly positive.. chest xray wnl.. elisa for HIV non reactive.. OCT shows macular edema in RE.. we started ATT after consulting with pulm med dept along with systemic steroids and topical nsaids suspecting eales with venous occlusion with macular edema.. he cant afford lucentis.. any suggestions regarding DD and management?

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Right eye fundus : media appears clear Mild disc pallor present vascular sheathing seen in ST and IT arcade suggestive if periphlebitis dot blot haemorrhages seen in all the quadrants macular star seen Left eye Again vascular sheathing noted in the superotemporal quadrant with multiple haemorrhages leading to an appearance of Inflammation induced ST BRVO Case looks like of vasculitis or commonly referred to as eales disease. Treatment will include 1. ATT 2. oral steroids. 3. PST in right eye as he has inflammation induced macular edema. 4. Do FFA to check for any areas of NVE. Laser the ischemic retina ie in case u note CNP areas as complaince is an issue with these patients and they come with VH if not lasered Case look

thank u mam
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My points for and against the other answers. 1. Could be sarcoidosis but sarcoidosis has intermittent areas of sheathing and vitritis and snowballs are hallmark. 2. Could be tubercular but patient is healthy and also no vit iritis. No granular lesion no choroiditis. 3. Its is not ST BRvo. If u lookcarefully the superrotemporal vein has sheathing right from the disc and the haemorrhage and the whitish oedema is around the artery. Not the vein. 4. Eales is a diagnosis of exclusion. Any vasculitis which u can't diagnose is Eales. And yes I agree it is never so symmetrical as in this case. 5. I think you should rule out frosted branch angititis. Look for all associations of angititis before giving it any other diagnosis. Total vein length periphlebitis., no vitritis, mild uveitis, angry looking retina no choroiditis, no snowballs, I would really rule out all associations of frosted branch angititis before leaving the patient and sitting relaxed on my treatment.

I will have to read about frosted branch angitis and get back to it.. but eales is usually bilateral although asymmetric.. it can present with periphlebitis leading to venous occlusions.. there is marked sheathing.. and mantoux was positive which is not confirmatory but we dont have pcr and other investigations here.. so we made a provisional diagnosis and started oral steroids along with ATT
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1. Eales is a typically unilateral disease. this is more likely to be sarcoidosis or one of collagen vascular diseases 2. considering weakly positive MT and normal chest X-ray is the toxic ATT justified. rather he may need systemic immunosuppressives.

Its a case of perphlebitis retinae ..well managed with systemic steroids and att. Do ffa also to see if any nve already developed then may need laser..for edema one can give avastin also.

I would appreciate if someone could enumerate the fundus findings in detail

Do FFA & OCT then PRP and Antivegf Look for sickle cell disease

right eye is vasculitis probably post TB with macular star.continue att .do FFA and look for any leaks.if not follow up.edema might resolve after att completion.left eye is venous occlusion .do ffa Oct.wait for haemmorhages to clear.give a month.then give avastin if necessary.

Hi manbir. I have weird feeling that something is a miss here. There are no snow balls. Less vitritis. No granuloma. No choroiditis. Healthy patient. Isn't this frosted branch angititis.

high dose steroids with att cover seems appropriate medical management.. if neovascularisation or extensive cnp areas on FFA, then will need laser accordingly

vasculitis retinae.look for sarcoidosisTuberculosis

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