30y male with DOV in BE since 3 months.. no H/O trauma or any systemic illness.. ant seg wnl.. fundus pic attached

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Larger whiter RNFL infarction ( cotton wool spots) with optic neuritis with CSME & superficial retinal hemorrhage bilateral involvement sexually active age highly indicates towards HIV neuroretinitis in both eyes. Patient needs to be well investigated and accordingly treated

RE : myelinated n.fibers & ? Lesion in macula . LE : cotton wool spots , & , superficial h'ge . Adv : f f angiography , ppbs , b.p measurement Also to investigate for Eale's disease .

We initially presumed it to be hiv microangiopathy as there were no vasculopathic risk factors like hypertension and diabetes.. but Elisa for HIV was negative.. so started steroids emperically as lesion appears like chorioretinitis

RE has juxtapapillary chorioretinitis.. LE has multiple chorioretinitis lesions.. according to senior faculty here.. started systemic steroids as all investigations were normal

The colour of lesions in each eye is whitish & not even slightly yellowish generally seen in chorioretinitis. More over chorioretinitis lesions will not obscure retinal blood vessels but myelinated nerve fibres do obscure them which is evident in the picture. Please reply.
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Right eye is having MNFL LEFT EYE- multiple cotton wool spots along with serous fluid temporal to disc with flame hemorrhage These is mild dilatation of vein superior to macula Do a systemic evaluation Oct FFA arm to retina and early phases

Rt eye seems to be medullated nerve fibre n lt eye shows sum cottonwool spots n haemorrhages so cud b periphlebitis as age suggests. Adv him ffa

@Dr. Arun Rajan sir please help

RE medullated fibres.LE has cotton wool spots and sup haemorrhage- suggestive of ischemic etiology.r/o hypertension and carotid occlusion as changes are predominantly in one eye

Myelinated not medullated
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Opaque nerve fibres

This patient had Ig M and Ig G positive for rubella on TORCH test

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