Unilateral Retinitis Pigmentosa Reported in 43-Year-old Woman
Unilateral retinitis pigmentosa presents rare ophthalmological challenges, with Cureus reporting the diagnosis of a 43-year-old woman suffering from progressive visual loss and night blindness over one year.
Key Clinical Takeaways:
- The patient exhibited classic features of retinitis pigmentosa strictly confined to her right eye, while her left eye remained entirely normal.
- Full-field electroretinography revealed severely attenuated dark-adapted and light-adapted b-wave amplitudes in the affected eye, confirming profound photoreceptor and bipolar cell dysfunction.
- Comprehensive screening ruled out infectious, toxic, and traumatic causes of unilateral pigmentary retinopathy.
The patient presented to clinicians with a one-year history of nyctalopia and visual deterioration in her right eye, as detailed in Cureus. Her medical history was otherwise unremarkable, and she reported no family history of similar ocular conditions or previous ocular trauma.
Anterior segment examinations showed clear corneas bilaterally with normal intraocular pressures and no vitreous cellular activity. Fundus evaluations of the right eye revealed attenuated retinal vessels alongside prominent midperipheral bone-spicule pigmentation and retinal pigment epithelium mottling. Conversely, the left fundus appeared entirely normal.
Optical coherence tomography demonstrated a distinct loss of the ellipsoid zone outside the fovea within the right eye. The left eye maintained normal retinal architecture across all scanned layers.
Full-field electroretinography was conducted in accordance with standards set by the International Society for Clinical Electrophysiology of Vision. Dark-adapted scotopic testing of the right eye yielded a b-wave peak-to-trough amplitude of 18.44 microvolts, compared to 161.3 microvolts in the left eye.
Light-adapted photopic recordings similarly displayed severe interocular asymmetry. The right eye recorded a b-wave amplitude of 13.70 microvolts, whereas the left eye registered 86.33 microvolts. These marked reductions confirmed extensive functional impairment across both the rod and cone systems of the right retina.
Clinicians performed an extensive evaluation to eliminate secondary or acquired causes of unilateral retinopathy. Standard hematological and biochemical screenings returned results entirely within normal reference ranges.
Laboratory testing yielded a hemoglobin level of 13 grams per deciliter, a white blood cell count of 6.1 thousand per microliter, and a platelet count of 150 thousand per microliter. Viral screenings for hepatitis B surface antigen, antibodies to hepatitis C, and human immunodeficiency virus types 1 and 2 were all negative, alongside a standard toxicology panel.
Typical retinitis pigmentosa manifests as a bilateral and symmetrical hereditary disease linked to rod photoreceptor degeneration followed by secondary cone loss. Unilateral retinitis pigmentosa remains an exceptionally rare clinical entity requiring strict diagnostic validation, including longitudinal follow-up to ensure the fellow eye remains unaffected.
Differentiating true unilateral pigmentary retinopathy from mimics requires ruling out conditions such as syphilis, vitamin A deficiency, and localized laser photocoagulation trauma.
Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.