PMC4780468_01
External examination of the left eye at initial presentation. A total retinal detachment is visible through the pupil along with diffuse retinal telangiectasias.
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F1
In the left eye, the retina was visible on external examination through the pupil (Fig. 1).
External exam two weeks after initial presentation. New exam findings noted at this time included conjunctival injection and xanthocoria.
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F2
External ophthalmic examination at this time revealed conjunctival injection and xanthocoria (yellow pupil), both new findings (Fig. 2).
B-scan ultrasonography obtained when patient returned with anterior chamber opacification. The image reveals massive subretinal exudation and retinal detachment expected with advanced Coats' disease.
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F3
B-scan ultrasonography revealed no masses or calcifications but did corroborate his previous retinal exam by showing massive subretinal exudation (Fig. 3).
Follow-up external examination of the left eye revealed the development of a total hyphema and a few residual cholesterol crystals.
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F4
In that week the right eye had developed a complete hyphema with continued evidence of anterior chamber cholesterol (Fig. 4).
(A) Low magnification view of thickened retina with diffuse inflammation, dilated capillaries (arrow), and subretinal exudation (asterisk). (B) Higher magnification view of intraretinal exudates (asterisk). (C) View of anterior segment and angle where there is evidence of blood in the anterior chamber, the posterior chamber, and the angle structures.
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Pathologic examination of the enucleated globe confirmed the diagnosis of Coats' disease with evidence of thickened and dilated capillaries as well as intraretinal and subretinal exudation (Fig. 5).