Loss of Vision After Surgery: What's the Cause?

Helene M. Kaiser, OD; Case Series Editor: Jean Marie Pagani, OD


July 08, 2014

Case Presentation: A Postoperative Complication

A 75-year-old white woman who had undergone surgical oophorectomy 8 days earlier suddenly experienced impairment of vision, which started in the right eye (OD), lasted 4 days, and then affected both eyes (OU).

In the postoperative period, she experienced a hypotensive crisis (blood pressure approximately 80/50 mm Hg) that lasted for 2 days. She also developed severe edema of the lower extremities 4 days postoperatively, which resolved with diuretic treatment.

Her medical history was significant for stage 3 ovarian cancer and breast cancer 8 months previously, which required surgery. She has had 1 myocardial infarction.

Eye Examination

The following were noted on eye examination:

  • Best corrected visual acuity: OD 20/30; left eye (OS) 20/40

  • Pupils equal, round, and reactive to light; no afferent pupillary defect

  • Extraocular movements: intact

  • Goldman applanation tonometer: 10 mm Hg OU

  • Slit-lamp examination: unremarkable except for mild nuclear/cortical lens changes

  • Maculae and peripheral retinae: clear OU

  • Dilated fundus examination: see Figure 1

  • Automated visual field testing: peripheral constriction denser inferiorly OD; superior altitudinal defect in the OS (Figure 2)

Figure 1a. Dilated fundus examination; optic nerves OS. 1b. Dilated fundus exam; optic nerves OD.

Figure 2a. Automated visual field testing; superior altitudinal defect OS. 2b. Automated visual field testing; peripheral constriction denser inferiorly OD.


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