Summary: Unilateral transient, long-duration repeated episodes of vision loss due to UGH syndrome (Uveitis, Glaucoma, Hyphema) from intraocular lens haptic (arm) rubbing up against posterior iris causing intermittent bleeding into anterior chamber
64-year-old women who has been experiencing episodes of haziness in vision
Inquiry: Bilateral vs Unilateral
Episodes can last a little as one hour when the vision is only mildly affected to as long as all day long for the episodes when vision is affected more severely.
Inquiry: Episode Characteristics
Positive phenomena, appears as a white out of vision and white haze.
Inquiry: Activity during the episode
Symptoms can last throughout the day regardless of activity
Inquiry: Pattern of visual loss
Complete white out of vision in right eye
Inquiry: Other Symptoms
There is no pain and no other symptoms
Inquiry: Current Medication
She saw a neurologist who put her on daily aspirin and since then the episodes have lasted longer
Inquiry: Other History Patient had cataract surgery in the right eye 6 years ago and right after surgery it was discovered that the wrong power intraocular lens was implanted so it was replaced the next day. The right eye has just never felt right since then. The episodes of white out of vision started about 6 months ago. The left eye also had cataract surgery 5 years ago and the surgery went without any problems.
The patient’s friend took a picture of her right eye during one of the episodes and this is what was seen:
The patient was then asked to come to the clinic later that week after the episode cleared and the slit lamp exam showed the following:
This photo shows that the haptic of the intraocular lens is rubbing against the back surface of the iris causing a pattern of transillumination defect that corresponded to where the haptic was rubbing off the pigment and causing intermittent bleeding from an iris vessel into the anterior chamber during an episode.
Ultrasound imaging demonstrating the following:
Displacement (tilting) of the intraocular lens causing the haptic to rub against the iris.