BACKGROUND: Coats’ disease is a unilateral, retinal vascular anomaly typically found in males in their first or second decade. Its etiology is not known. Focal or multifocal areas of retinal vascular abnormalities with edema, hard exudates, and aneurismal or saccular vessel outpouchings are often found. Capillary nonperfusion and leakage are common on fluorescein angiography. If untreated, the accumulation of exudates and fluid will lead to scar formation and retinal detachment. Treatment consists of controlling vessel leakage with cryotherapy or laser photocoagulation.
CASE REPORT(S). A 22-year-old white male college student presented to our clinic with a history of conjunctivitis OS for two weeks. He had been using Gentamycin 0.3% ophthalmic solution every 3-4 hours as prescribed by his family physician. The patient had run out of the medication and was hoping to have it refilled. The patient reported symptoms of mild conjunctival redness and itching OS. Noticeable blur and light flashes OS were revealed with further questioning. Uncorrected entrance visual acuity was 20/20 OD and 20/50 OS, improving to 20/25- OS with a pinhole. The bulbar conjunctiva OS had grade I nasal injection. The anterior ocular assessment was otherwise unremarkable OD and OS. A dilated fundus exam revealed a large multifocal area temporal to the macula of retinal thickening, saccular vessel outpouching and surrounding exudates in the left eye. This patient underwent 3 laser photocoagulation treatments OS, and his best corrected visual acuity OS was 20/40 two months following his last treatment.
CONCLUSIONS. This patient presented with what appeared to be a simple conjunctivitis. Had his retinal condition been left undiagnosed and untreated, this could have been visually devastating for this young man. The following case report will outline Coats disease and it’s variants as well as treatment and management options.