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JAMA Ophthalmology Clinical Challenge
September 2017

A Woman With a Spot in Her Vision

Author Affiliations
  • 1Department of Ophthalmology, Duke University, Durham, North Carolina
  • 2Departments of Neurology and Neurosurgery, Duke University, Durham, North Carolina
JAMA Ophthalmol. 2017;135(9):997-998. doi:10.1001/jamaophthalmol.2017.0426

A 66-year-old white woman presented with a 2-month history of a “cloudy spot” in her left eye. She denied eye pain, transient vision loss, photophobia, or photopsias but reported right-sided jaw pain migrating to include both temples, ears, neck, and left shoulder. The jaw became more painful and fatigued with chewing, associated with an 3.6-kg weight loss over 3 months. A mouth guard prescribed by her dentist for temporomandibular joint disease had provided substantial relief over the past 2 months. She denied any history of hypertension, hyperlipidemia, type 2 diabetes, or human immunodeficiency virus exposure but had a 20 pack/year cigarette smoking history.