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Coccidioidomycosis is usually localised in the eye either to the anterior or to the posterior segment, but only rarely to both.1–8 We present a case in which the initial infection involved the anterior segment, but was followed by extensive superficial retinal seeding after vitrectomy. Retinal involvement after vitrectomy raises the possibility of the anterior hyaloid face acting as a barrier to spread of the fungus posteriorly. A review of prior cases indicates that, in the absence of vitrectomy, retinal involvement does not occur in anterior segment coccidioidomycosis.
A 64-year-old man had been treated 3 years previously for iritis and secondary ocular hypertension with topical prednisolone acetate 1% and timolol 0.5%, with alleviation of symptoms. He presented with recurrence of similar symptoms that did not resolve with topical, retroseptal, and systemic corticosteroids and glaucoma drugs. A detailed systemic evaluation was negative.
On examination, the right eye was unremarkable. Visual acuity of the left …