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JAMA Ophthalmology Clinical Challenge
January 2017

An Unusual Cause of Unilateral Vision Loss

Author Affiliations
  • 1Ophthalmology Macular Service, Belfast Health and Social Care Trust and Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
  • 2Department of Ophthalmology, Scientific Institue San Raffaele, Vita-Salute University, Milan, Italy
JAMA Ophthalmol. 2017;135(1):69-70. doi:10.1001/jamaophthalmol.2016.2730

A 64-year-old man was referred to our clinic for suspected central retinal vein occlusion (CRVO) in his right eye. He had experienced blurred vision of the right eye for 2 months; medical history included hypercholesterolemia. Best-corrected visual acuity was 20/80 OD and 20/20 OS. The anterior segment was normal and intraocular pressure was 16 mm Hg in both eyes. Dilated fundus examination of the right eye revealed a normal optic disc, mild venous engorgement, and widespread peripheral dot-blot retinal hemorrhages mainly located in the temporal midperiphery (Figure 1A). No spontaneous retinal arterial pulsation was noted. Examination findings of the left eye were unremarkable. Fluorescein angiography in the right eye showed delayed venous filling, mild perifoveal leakage, and scattered microaneurysms in the temporal sector (Figure 1B).