A 25-year-old Asian Indian male patient was seen by us 8 months following penetrating trauma to his left eye. He had developed defective vision of 4-month duration in the left eye and 3 months in the right eye. He had been treated with topical steroid drops but continued to have diminishing vision. He developed pain and defective vision in the right eye. He had undergone a vitrectomy with endolaser and intraocular foreign body removal in his left eye elsewhere before he was referred to us. He had a history of eruptive Lichen planus several years ago for which he was treated with a course of oral prednisolone. His best-corrected visual acuity was 6/9 and N6 in the right eye and no perception of light and less than N36 in his left eye. Applanation tonometry was 10 mm in the right eye and not recordable in the left eye as it was very soft. Slit-lamp examination of the right eye revealed mutton-fat keratic precipitates and aqueous cells1 + and aqueous flare 1+. The cornea and pupil were normal. Left eye had pigments on the corneal endothelium, early cataract, and posterior synechiae but no anterior chamber reaction. Fundus examination of the right eye showed 1+ vitreous haze and disc hyperemia with multiple Dalen-Fuchs nodules, perivascular retinitis, and extensive vascular sheathing, and the left eye had no view of the fundus [Figure 1]. Fundus fluorescein angiography showed a perivasculitis with an FBA-like picture. Optical coherence tomography in the right eye revealed an altered foveal contour, an epiretinal membrane, retinal thickening nasal to the fovea with posterior vitreous detachment, and a bumpy retinal pigment epithelial cell layer. Ultrasonography in the right eye showed peripapillary choroidal thickening of 1.6 mm. Investigations for sarcoidosis and tuberculosis was negative. As the patient required immunomodulators and immunosuppressives such as cyclosporine and azathioprine, respectively, his blood urea, creatinine, blood pressure, and full blood count were done and found to be normal. There was no evidence of systemic infections. We started the patient initially on tablet azathioprine 50 mg 3 times daily and tablet prednisolone 60 mg along with antacid and calcium supplements.
The inflammation continued and tablet cyclosporine, 150 mg twice daily was added to his treatment. He improved significantly, and examination showed no anterior chamber and vitreous cells. The perivasculitis and hyperemia of disc resolved after 4 months of treatment. The vision at the end of 3 months of treatment is now 6/6, N6 in the right eye, and inaccurate projection of light in the left eye. The immunosuppressives are being tapered now, and the patient is being followed up at regular intervals. Follow-up of 1 year showed no reactivation.