Summary: Unilateral Transient Visual Loss due to impending arteritic anterior ischemic optic neuropathy (AAION) from giant cell arteritis (severe narrowing of posterior ciliary artery before impending occlusion)
80-year-old white female that has noticed repeated episodes of sudden darkening of vision.
Inquiry: Bilateral vs Unilateral
Patient Response: unilateral, right eye only for each episode
Each episode has a duration of less than a minute
Inquiry: Episode Characteristics
Negative visual phenomenon (darkening of vision)
Inquiry: Activity during the episode
Episodes of darkening of vision occurred while standing upright from sitting position or when she bends over to pick up laundry from the floor and rises to standing position.
Inquiry: Pattern of visual loss
Repeated episodes of sudden darkening of entire vision in the right eye only.
Inquiry: Other Symptoms
10 lb. (4.5kg) weight loss in the last 6 months, flu-like symptoms and mild low-grade fever. Has been having some hip and neck pain the last 3 months. She went to her hairdresser 3 weeks ago and was experiencing some pain during her comb-out after a shampoo. She also has had two episodes of horizontal diplopia lasting less than a minute in the last 2 weeks.
Inquiry: Current Medication
The patient is on anti-hypertensive medications for high blood pressure.
Exam: normal vision of 20/20, no relative afferent pupil defect. Ocular motility normal. Intraocular pressure 13 mmHg OU. Dilated fundus exam showed normal retina, macula and optic nerves
Further exam: when pressing on her globe, the retinal artery collapsed in the right eye with very little digital pressure on the eye, and the left eye’s central retinal artery did not collapse until moderate digital pressure was given
Testing: fluorescein angiogram showed delayed patchy choroidal filling in the right eye during the early phase and delayed filling of the central retinal vein (delayed arterial- venous filling time of greater than 4 seconds).