![]() The fundus of the right eye was unremarkable. The slit-lamp evaluation identified mild to moderate nuclear sclerotic cataracts. The patient's best corrected visual acuity was 20/25 in the right eye and 20/60 in the left. His medications included hydrochlorothiazide and atorvastatin. He had no new headaches or jaw claudication. Shortly after awakening, an 82-year-old man with a history of cataracts in both eyes noticed a sudden painless diminution of vision in the left eye. This patient was referred to her internist for further evaluation. Systemic conditions must be identified and treated. In acute presentations, ocular massage, rebreathing in a paper bag, or anterior chamber paracentesis may be tried. ![]() There is no effective treatment for patients who present several hours or days after onset. This neuroretinal ischemic disorder is often associated with conditions that lead to embolus formation but is also seen in patients with coagulopathies, collagen vascular and inflammatory disorders, and vasculitides and in patients with systemic abnormalities such as untreated or undertreated hypertensionand diabetes. This patient had experienced an arterial occlusive event, probably of the central retinal artery in the left eye. The fundus of the left eye showed a foveal cherry-red spot retinal whitening and opacification surrounding the fovea and retinal arterial thinning with segmentation, or "boxcarring." Her seated blood pressure was 200/82 mm Hg in the right arm and 192/80 mm Hg in the left. Results of the funduscopic examination of the right eye were unremarkable. ![]() She had a left afferent pupillary defect. The patient's initial visual acuity was 20/20 in the right eye and light projection in the left eye. Her medications included ramipril, 2.5 mg/d aspirin, 81 mg bid and a multivitamin. *Ī 73-year-old woman presented for evaluation because of a sudden severe but painless loss of vision in her left eye 2 days earlier. The preretinal hemorrhage in the left eye is another sign of proliferative diabetic retinopathy, which is treated with laser panretinal photocoagulation. The patient's other retinal hemorrhages and hard exudates are common in moderate diabetic retinopathy. The optic disc neovascular vessels had begun to leak, and the blood settling over the macula manifested as a cloud in the patient's vision. Proliferative diabetic retinopathy was diagnosed. Because the bleeding was not near the patient's line of sight, she had not experienced visual difficulties in this eye. A large preretinal hemorrhage was detected in the infranasal quadrant of the left eye ( B). Dot and blot retinal hemorrhages were scattered throughout the posterior pole. No rubeosis of the iris was found on gonioscopic evaluation.Ī funduscopic examination demonstrated neovascularization of the optic disc, with blood in the vitreous directly over the macular area of the right eye. A slit-lamp examination revealed mild nuclear sclerotic changes in the lenses of both eyes. Her pupils and intraocular pressures were normal in both eyes. The patient's best corrected visual acuity was 20/40 in the right eye and 20/25 in the left. Her optometrist told her that new blood vessel growth and leakage had developed. ![]() A 54-year-old woman with a 10-year history of insulin-dependent type 2 diabetes mellitus was referred by her optometrist because of the recent onset of blurrinessin her right eye.
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