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JAMA Ophthalmology Clinical Challenge
September 2016

Persistent Blurry Vision After a Routine Eye Examination

Author Affiliations
  • 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston
JAMA Ophthalmol. 2016;134(9):1065-1066. doi:10.1001/jamaophthalmol.2016.0812

An otherwise healthy woman in her 50s was evaluated in the emergency department for persistently blurry vision in both eyes after a routine eye examination with dilation 5 days earlier. She had a history of high myopia, astigmatism, and mild cataracts, as well as narrow angles, for which she had undergone laser peripheral iridotomy in both eyes a number of years earlier. Her review of systems was normal, and she had no relevant family history of ocular disease. The best-corrected visual acuity measured 20/100 OD and 20/200 OS, with manifest refractions of −9.00 −1.25 × 090 OD and −8.50 −0.75 × 086 OS. Intraocular pressure measured 12 mm Hg OU. The pupils were middilated and poorly reactive. There were patent peripheral iridotomies bilaterally. The lenses were displaced into the anterior chambers without any lenticular zonules visible. There was central lenticulocorneal touch bilaterally with trace Descemet membrane folds at the points of contact (Figure). The posterior segment examination results were unremarkable. More detailed examinations of the patient’s stature and habitus, as well as of the hands specifically, did not reveal any abnormalities.