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JAMA Ophthalmology Clinical Challenge
November 2013

More Than Just Optic Disc Swelling

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. 2013;131(11):1477-1478. doi:10.1001/jamaophthalmol.2013.7013

A healthy woman in her 50s presents with sudden-onset, painless blurred vision in her right eye. She describes it as a black lace over her field of vision that she first noticed after waking 8 days prior to presentation. Owing to worsening vision, she was referred to us for further evaluation. She has no systemic symptoms and no past ocular or systemic health problems. She does not take any medications. She is currently working and lives at home with her male partner and her pets. She is a nonsmoker and drinks alcohol socially. Her best-corrected visual acuity is 20/200 in the right eye and 20/20 in the left eye, with a right relative afferent pupil defect. The results of a slitlamp examination of the intraocular pressure, motility, and anterior segment in both eyes are unremarkable. Dilated examination findings of the left eye are normal. Results of a dilated examination of the right eye reveal a clear vitreous body, tortuous veins, and macula lutea, as shown in Figure 1.

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