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
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
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.