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A 44-year-old woman with primary anti-phospholipid syndrome (APS) was admitted under the care of the rheumatologists for treatment of an infected pyoderma gangrenosum. During her admission she complained of decreased vision and pain on eye movements associated with a headache. Ocular examination revealed a visual acuity of 20/60 in the right eye with a right relative afferent pupillary defect, and 20/40 in the left eye. Both eyes had reduced colour vision on Ishihara plate testing, with almost no colour vision in the right eye. Extraocular movements were full with no diplopia. Anterior segment examination revealed bilateral conjunctival chemosis, episcleral and scleral injection. Intraocular pressure was 12mmHg in both eyes, and both anterior chambers were quiet. Fundoscopic examination showed bilateral multifocal collections of subretinal fluid involving the posterior segment, as well as mottling of the retinal pigment epithelium.

1.	What is/are the likely diagnosis(es)?
	a. anterior scleritis b. toxoplasmosis c. anterior uveitis d. posterior scleritis e. central retinal vein occlusion f. (a) and (d)
2.	What investigation(s) would be the most useful for this patient?
	a. MRI orbits b. B-scan ultrasound c. fundus fluorescein angiography d. visual fields e. DEXA scan f. (a), (b), and (c)
3.	Posterior scleritis can be associated with the following condition(s):
	a. toxoplasmosis-induced posterior uveitis b. systemic lupus erythematosus (SLE) c. chronic lymphocytic leukemia d. rheumatoid arthritis e. anti-phospholipid syndrome f. all of the above

For answers to the above, click here on or after October 6, 2009.