A 66-Year-Old Woman With Central Vision Loss

Ronald C Gentile, MD; Brooke Nesmith, MD

Disclosures

November 02, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 66-year-old woman presents with new-onset decreased vision in the right eye with distortion. She experienced similar symptoms in the left eye more than 6 months earlier, which progressed to a central scotoma, but she did not seek medical attention at that time. She reports no eye pain, diplopia, or other ocular symptoms.

Otherwise, her ocular history is unremarkable, but her medical history is positive for hypertension, controlled on atenolol (50 mg/d) and amlodipine (10 mg/d). Her social and family history is unremarkable and negative for anemia. A review of symptoms reveals occasional headaches with difficulty hearing on the left side. She recently required a cane to ambulate, but she attributes this to arthritis in the knees and hips. She reports the inability to wear hats, especially her prized Easter bonnets.

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