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JAMA Ophthalmology Clinical Challenge
August 22, 2019

Acute Onset of Blurry Vision in a Young Man

Author Affiliations
  • 1Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago
JAMA Ophthalmol. Published online August 22, 2019. doi:10.1001/jamaophthalmol.2019.3058

A 25-year-old man presented to an ophthalmologist outside the authors’ department with acutely decreased visual acuity in both eyes. He had woken up earlier that morning with normal visual acuity, but his visual acuity had progressively worsened to the point that he was unable to work. He denied additional symptoms, other than mild tearing. Per his ophthalmologist, his visual acuity improved with a −10 diopter lens, but his intraocular pressure was elevated to between 30 and 40 mm Hg OU. The patient was sent to the emergency department, where the authors’ consultation team evaluated him. The patient’s medical history was remarkable for hypertension and asthma. He denied smoking, drinking alcohol, and using recreational drugs. A review of symptoms was otherwise negative. His medications included losartan, albuterol, and fluticasone. On examination, his visual acuity was 20/400 OU (while wearing prescription lenses, −2.75 + 1.00 × 090 OD and −2.50 + 1.00 × 081 OS). His best-corrected visual acuity was 20/25 OU (manifest refraction, −12.00 + 1.75 × 097 OD and −10.75 + 0.25 × 050 OS). His intraocular pressure was 19 OU. Sensorimotor and external examination results were normal. A slitlamp examination revealed mild diffuse vasodilation and temporal chemosis, clear corneas, shallow anterior chambers, and clear lenses in both eyes. A gonioscopic examination showed no angle structures in either eye. Results of an undilated fundus examination was unremarkable. Figure 1 shows ultrasonographic images of his eyes.