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JAMA Ophthalmology Clinical Challenge
February 20, 2020

Acute-Onset Visual Acuity Loss in a Man With Advanced Diabetes Mellitus

Author Affiliations
  • 1Illinois Eye and Ear Infirmary, University of Illinois at Chicago
JAMA Ophthalmol. 2020;138(4):416-417. doi:10.1001/jamaophthalmol.2019.5388

A 67-year-old man presented to the emergency department in October with acute-onset visual acuity loss in the right eye of 2 days’ duration associated with right periorbital pain. His medical history was remarkable for diabetes mellitus of 40 years’ duration complicated by end-stage renal disease requiring a renal transplant and ongoing immunosuppression. His visual acuity was no light perception OD and 20/40 OS. The right eye exhibited an amaurotic pupil, severe generalized restriction of extraocular movement, and ptosis with poor levator function. His intraocular pressures were normal. At a base of 104 mm, exophthalmometer measurements were 24 mm OD and 20 mm OS. The results of a slitlamp examination were noncontributory in both eyes. A dilated fundus examination revealed a pale optic disc in the right eye and panretinal laser scars in both eyes. Cranial nerves V and VII-XII were intact bilaterally. The patient was afebrile, with vital signs within normal limits. His leukocyte count was 2200 cells/μL (to convert to ×109/L, multiply by 0.001).

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