Primary Idiopathic Frosted Branch Angiitis

A five-year-old boy presented to the ophthalmology emergency department with a three-day history of sudden onset of severe visual impairment in both eyes. He experienced an upper respiratory tract infection (URTI) two weeks before the presenting complaint. On initial ophthalmic examination, his visual acuity was hand motion with projection OU. He had no relative afferent pupillary defect, and had normal intraocular pressure. The visual reduction was not associated with pain or injection. Slit-lamp examination of both eyes showed mild anterior chamber (AC) reaction (1–2+ cells), moderate bilateral presence of vitreous cells (2–3+ cells), but no keratic precipitates. A dilated fundus examination of both eyes revealed mild vitreous haziness and bilateral symmetrical and widespread retinal vasculitis. There was a prominent and florid translucent retinal perivascular infiltration that predominantly affected the venules, starting from the posterior pole and extending up to the periphery. Bilaterally, mild to moderate papillitis and severe macular edema was noted without any obvious retinal hemorrhages.