A 36-Year-Old Man With Blurred Vision and Hypertension

Carlo R. Bernardino, MD

Disclosures

July 25, 2013

Clinical Presentation

A 36-year-old Hispanic man was referred for suspected glaucoma 4 years ago. At that time, he was seen by an optometrist for a routine eye examination. He denied any visual symptoms. His medical history was significant for hypertension.

On ocular examination, his best-corrected visual acuity was 20/25. He had normally reactive pupils with no afferent pupillary defect. Visual fields were full to confrontation in both eyes. Ocular motility was full.

Intraocular pressures were 19 mm Hg in the right eye and 17 mm Hg in the left eye. Examination of the anterior segment was unremarkable, and fundus examination was normal. Cup-to-disc ratios were 0.7 in the right eye and 0.6 in the left eye (Figure 1). The patient was diagnosed as glaucoma suspect, and automated visual field testing was advised.

Figure 1. Color photographs of the optic disc in the right eye (a) and left eye (b), demonstrating normal posterior poles with cup-to-disc ratios of 0.7 in the right eye and 0.6 in the left eye.

The patient failed to follow up and returned 3 years later with blurred vision in both eyes. His medical history was significant for hypertension and recent hospitalization for hypertensive crisis.

On ocular examination, his visual acuity was 20/25 in the right eye and 20/20 in the left eye. There was no afferent pupillary defect. Confrontation visual fields were significant for bilateral inferior visual field cuts. Intraocular pressures were 21 mm Hg in the right eye and 14 mm Hg in the left. Examination of the anterior segment was unremarkable. Fundus examination was unremarkable. Cup-to-disc ratios were 0.7 in both eyes.

Automated visual field testing was performed (Figure 2). Marked bilateral visual field defects with central sparing were seen in both eyes.

Figure 2. Humphrey 30-2 visual field testing in the right eye (a) and left eye (b), demonstrating marked inferior visual field defects with central sparing.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....