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JAMA Ophthalmology Clinical Challenge
November 2014

Acute Postoperative Visual Loss

Author Affiliations
  • 1Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami, Florida

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JAMA Ophthalmol. 2014;132(11):1365-1366. doi:10.1001/jamaophthalmol.2014.3352

A 50-year-old healthy woman underwent an uncomplicated elective clipping of a right middle cerebral artery aneurysm via pterional craniotomy. Ophthalmology was consulted urgently in the recovery room because of complaints of vision loss and ophthalmoplegia in the right eye. On examination, visual acuity was no light perception (NLP) OD and 20/20 OS. Pupils were equal and round, with a 3+ relative afferent pupillary defect in the right eye. Intraocular pressure was within normal limits in both eyes. There was complete ophthalmoplegia in the right eye with no signs of restriction on forced ductions and normal motility in the left eye. Visual field was full to confrontation in the left eye. The right eye also demonstrated mild fullness of the orbit, right cheek skin erythema, trace proptosis, and trace conjunctival chemosis. Posterior examination was significant for diffuse retinal whitening with a cherry-red spot in the macula in the right eye (Figure 1A). There were no other neurologic deficits identified on examination.

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