On examination, his corrected visual acuity was 20/30 OD and 20/40 OS.
Both corneas were clear, and his left conjunctiva was hyperemic, although
there was no conjunctival venous sludging. His left pupil was slightly irregular,
and there was evidence of low-grade anterior chamber activity (indicated by
a few cells and mild flare) with secondary localized posterior synechiae.
However, the most striking clinical abnormality was a white, solid, well-demarcated
pseudohypopyon of undetermined source occupying the inferior anterior chamber
and slightly extending medially (Figure 1). There was no evidence of crystals within the cornea or infiltration
of the iris. Intraocular pressures were within normal limits, and ophthalmoscopy
results were unremarkable in both eyes, with the absence of retinal venous
stasis, cotton-wool spots, or optic disc swelling. Although the lesion was
simulating a hypopyon, there was no strong evidence of an infective underlying
cause, so the patient began taking mild topical steroids (0.5% prednisolone
ophthalmic drops, 4 times daily). A sample of the infiltrate was obtained
through a corneal paracentesis. Cytology results confirmed the presence of
monoclonal plasma cell infiltration. The patient underwent 10 courses of radiotherapy
to the left orbit with subsequent complete resolution of the pseudohypopyon
(Figure 2). After treatment began,
the cellular activity in the anterior chamber and the pseudohypopyon resolved,
and the patient's visual acuity improved to 20/30 in the affected eye.