Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

A Case of Sudden Monocular Blindness
Kroh, S, DO, Quas, M, MD
Kent Hospital, Emergency Medicine Residency Program, Warwick, RI
Introduction: A wide variety of causes exists for monocular vision loss. Retinal
artery occlusion, retinal vein occlusion, acute angle glaucoma, corneal abrasion,
endophthalmitis, episcleritis, Foreign Body, intraocular giant cell arteritis
(temporal arteritis), migraine, trauma/hyphema, optic neuritis, compressive
papilledema, retinal detachment, scleritis, sickle cell disease, and corneal ulcer
are a few of the possibilities. Retinal vein occlusion is the second most common
cause of vision loss worldwide second to diabetic retinopathy. Our patient
presents with evidence of central retinal vein occlusion (CRVO) secondary to
noncompliance with glaucoma medication.
Case: An 87 year old female presents to the emergency department with sudden
onset painless left eye blindness. She slept unusually late and this was present
upon waking. She had no light perception in her left eye. Her past medical history
included diabetes, hypertension, hypothyroidism, and mild dementia. She
mentioned a vague history of using “eye drops” for glaucoma but has not seen an
ophthalmologist in over four years. On exam the patient’s vital signs were stable.
She had exophthalmos of the left eye. Visual acuity was 20/30 in the R eye with
no light perception in the left. Intraocular pressure was 29 in the right eye and 82
in the left. Fundoscopic exam revealed blurring of the optic disc with a diffuse
retinal hemorrhages consistent with central retinal vein occlusion. The patient
was given aspirin and consultation with ophthalmology was obtained.
Unfortunately for this patient, nothing further could be done acutely and follow up
was arranged for the following day.
Discussion: The etiology of this patient’s central retinal vein occlusion (CRVO)
is likely secondary to noncompliance with glaucoma medication. Conversely
CRVO can cause glaucoma if not already present. Many patients will recover
some amount of vision. However, the prognosis for our patient is poor due to the
complete lack of light perception.