Shivakumar Mallappa 1 , Kaushal Kumar 2 , Soumyadeep Hazra 3 , Moumita Hazra
PRESENTATION OF CASE A 25-year-old patient presented with complaints of swelling of both the eyes, which was insidious in onset, painless and was gradually progressive since last 1 week, which was associated with painless gradually progressive diminution of vision. She also complained of painful oral ulcers and few rashes over the face involving the cheeks and forehead since one week. She gave a history of typhoid fever 1 month back, which was associated with difficulty in breathing and swallowing. On examination, vision in both eyes were reduced to counting fingers from 2 metres with pinhole improvement of 6/24. Anterior segment showed periorbital oedema, swollen eyelids along with congestive conjunctiva and grade 2 chemosis. Cornea was clear with no cataractous changes of lens in both the eyes. Pupil was round, regular and reactive for both the eyes. Schirmer's test showed 12 mm and 10 mm wetting of the paper after 5 minutes for right and left eye respectively, which indicated mild dryness of eyes. Fluorescein staining was normal confirming absence of any corneal epithelial defect. Diplopia charting, noncontact tonometry and perimetry findings were within normal limits. On fundoscopy, there was severe arteriolar attenuation along with presence of few cotton wool spots, hard exudates bilaterally and mild tortuosity of vessels in left eye without any signs of vitreous haemorrhage or retinal detachment. Bscan and OCT scanning findings were normal without any signs of haemorrhage or detachment. On fluorescein angiography, there was capillary dropout, vessel wall staining and leakage from vessels. Systemic examination was normal with no palpable lymphadenopathy.