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Case #31921378

Summary: Unilateral transient visual loss after retching episodes following motor vehicle accident with orbital fracture (due to intermittent air in the orbit)


A 26-year-old male was taken to the emergency room after being involved in a motor vehicle accident with subsequent transient visual loss.

Inquiry: Bilateral vs Unilateral

Inquiry: Duration
A few minutes per episode, episodes about 10 minutes apart.

Inquiry: Episode Characteristics
Complete black out of vision

Inquiry: Activity during the episode
During retching (reverse movement of the stomach and esophagus without vomiting) in ER

Inquiry: Pattern of visual loss
Complete black out in right eye only.

Inquiry: Other Symptoms
Motor vehicle accident, currently nauseated

Inquiry: Current Medication
No medications

Exam Results

On exam, during the episode the vision was bare light perception OD and 20/20 OS.

There was a rather large relative afferent pupil defect in the right eye.

Ocular motility was normal.

Intraocular pressure was 26 mm Hg OD and 15 mmHg OS.

A few minutes later, vision returned to 20/20 in the right eye and there was no RAPD.

Dilated fundus exam revealed a normal retina and optic nerve.