PUBLICATION EXCLUSIVE: Man presents with 1-month history of bilateral intermittent blurred vision

A 57-year-old man presented to the Lahey Medical Center ophthalmology clinic with a 1-month history of transient blurred vision in both eyes. His medical history was significant for hypertension, diabetes type 2, osteoarthritis, chronic back pain and a cholesteatoma, which was surgically treated with right tympanomastoidectomy 6 weeks before presentation. His ocular history was significant only for mild myopia, for which he was already wearing glasses.

On evaluation in the eye clinic, he endorsed a month-long history of intermittent blurred vision. He noted recurrent episodes of vision loss in both eyes that lasted only a few seconds. The patient noticed the vision would get very blurry and dim. Between these episodes, the vision returned to normal. He was unsure if the vision loss was positional. He was experiencing more frequent episodes, which prompted him to schedule an eye exam. He denied any headaches, nausea or vomiting. He did not endorse any pulsatile tinnitus or increased intracranial noises. He felt systemically well and had no recent sick contacts. He denied any scalp tenderness, jaw claudication, fevers, weight loss, fatigue or myalgias. He had no recent travel.

Examination

Initial exam in the ophthalmology clinic showed a best corrected visual acuity of 20/30 in the right eye and 20/40 in the left eye. Both pupils were briskly reactive, and there was no afferent pupillary defect in either eye. Color vision, evaluated by HRR pseudoisochromatic plates, was full in both eyes. Extraocular muscle movements were normal, and the patient was orthophoric in primary gaze at distance and near. Anterior segment exam was normal in both eyes. There was a mild nuclear sclerotic cataract in both eyes. No anterior or posterior cell was appreciated.

Click here to read the full publication exclusive, Grand Rounds at the New England Eye Center, published in Ocular Surgery News U.S. Edition, April 25, 2017.