An Elderly Patient's Blurry Right Eye Raises Questions

Karima S. Khimani; Rod Foroozan, MD


July 24, 2017

Clinical Presentation

A 77-year-old woman presents with blurry vision, as well as a 2-week history of flashes and floaters, in her right eye.

The patient has a medical history of hypertension, peripheral vascular disease, and coronary artery disease. She has had cataract surgery in each eye and a vitrectomy in the left eye for epiretinal membrane. She has a family history of cataracts, diabetes mellitus, and heart disease. The patient is a former smoker but does not drink alcohol or smoke tobacco now. The patient is currently using lubricating eye drops for dry eyes.

Best corrected visual acuity was 20/100 in the right eye and 20/15 in the left eye. Color vision testing with Ishihara pseudoisochromatic plates was 7/9 in the right eye and 8/9 in the left eye. Amsler grid testing showed distortions in the right eye. Pupils were brisk in both eyes with no relative afferent pupillary defect. Automated perimetry showed mildly decreased sensitivity superiorly and inferiorly in an arcuate pattern in both eyes. Intraocular pressures were 12 and 15 mm Hg in the right and left eyes, respectively.

Slit-lamp examination of the anterior segment and funduscopic examination showed slight retinal nerve fiber layer (RNFL) opacification in the right eye; the left eye was normal.

Optical coherence tomography (OCT) showed elevation of the RNFL in the right eye (Figure 1). Intravenous fluorescein angiography (Figure 2) showed no evidence of leakage of the optic disc in the right eye. OCT of the macula showed normal anatomy bilaterally.

Figure 1. OCT of the RNFL of the right eye, showing hyperintensity in the vitreous, consistent with vitreous causing elevation of the optic nerve head.

Figure 2. Fluorescein angiography of the right eye, showing no evidence of leakage of the disc.


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