A Painful Red Eye

Abstract

Aman in his 40swith a history of sinusitis presentedwith a 2-month history ofworsening pain and redness of the right eye and nasal congestion. Hewas previously diagnosedwith conjunctivitis and treatedempiricallywith artificial tears, ofloxacindrops (0.3%), andprednisolone acetate drops (1%) 4 times a day, without improvement. His visual acuity was 20/20 OD. Examination findings of the anterior segment of the right eye revealed a raised, nonmobile, engorged perilimbal nodule in the inferotemporal sclera that was tender to palpation and did not blanch with phenylephrine drops (2.5%) (Figure,A). Theultrasonogramdemonstratedanoncystic, regular,dome-shaped lesionwith medium tohigh reflectivity localized to the sclerawithout intraocular involvement (Figure, B). The remaining results of the right-eye examination and the entire left-eye examination werewithin the reference range. In addition, the patient had a right-sided intranasalmass. Laboratory test results demonstrated elevated inflammatory markers, with an erythrocyte sedimentation rateof 38mm/h (reference range,0-20mm/h) andaC-reactiveprotein level of 190mg/L (reference range, 0.08-3.1 mg/L) (to convert to nanomoles per liter, multiply by 9.524). Results of serum antineutrophil cytoplasmic antibody (ANCA), rheumatoid factor, antinuclear antibody, angiotensin-convertingenzyme, fluorescent treponemal antibody absorption, rapid plasma reagin,andtuberculosisskintestingwerewithintheir reference ranges. Results of urinemicroscopy had4+ red blood cells per high-power field. His blood urea nitrogen and creatinine levels were within their reference ranges. A B