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JAMA Ophthalmology Clinical Challenge
March 2018

Acute Monocular Vision Loss in a Young Adult

Author Affiliations
  • 1School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
  • 2Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York
JAMA Ophthalmol. 2018;136(3):297-298. doi:10.1001/jamaophthalmol.2017.4068

A woman in her 20s was referred to our retina clinic for blurry vision in the left eye that she noticed on waking. Her medical history was negative for diabetes, hypertension, dyslipidemia, and smoking. Her only medication was oral contraception (OCP). The patient’s uncorrected visual acuity was 20/20 OU, and intraocular pressures were 14 mm Hg OD and 15 mm Hg OS. Confrontational visual fields and results of external eye examination were normal. She had full ocular motility and no afferent pupillary defect. Results of the right eye fundus examination were unremarkable (Figure, A). The left eye (Figure, B) had tortuosity and dilation of all branches of the retinal vein, disc edema, scattered intraretinal hemorrhages, and nasal macula nerve fiber layer infarcts. The vitreous was clear, macula flat, and there was no retinal neovascularization. Results of optical coherence tomography confirmed the absence of cystoid macular edema and demonstrated nerve fiber layer thickening and hyperreflectivity, consistent with a nerve fiber layer infarct.