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A woman in her 50s presented with painless bilateral vision loss that developed over a period of 2 weeks to the point that she was unable to appreciate light in either eye. Two weeks prior to her visual symptoms, she had noticed intermittent painless, postmenopausal vaginal bleeding.
Her medical and ocular history were unremarkable. Her examination reults 2 years prior were normal, with a visual acuity of 20/20 OU.
In the emergency department, the patient had a computed tomographic scan of the brain and orbits that was normal, and she was referred to Ophthalmology. Ophthalmologic examination revealed a visual acuity of no light perception OU. Pupils were unreactive to light but constricted to a near target. Extraocular movements were full. Slitlamp examination of the anterior chamber revealed mild nuclear sclerosis in each eye and quiet anterior chambers. A dilated fundus examination is shown in the Figure. Neurological examination results were within normal limits.
Micieli JA, Lam K, Margolin EA. Vision Loss With Postmenopausal Bleeding. JAMA Ophthalmol. 2016;134(7):831-832. doi:10.1001/jamaophthalmol.2015.5005