Thinking Outside of the Lines

A 61-year-old male with past medical history of long-standing cocaine abuse presented with ten days of painless acute vision loss in his right eye (OD). Initial exam revealed a visual acuity (VA) 20/100 OD, relative afferent pupillary defect (rAPD) OD, dyschromatopsia OD, hypertropia with impaired infraduction and adduction OD, and 2 mm of OD proptosis. Dilated fundus examination revealed 360 degrees of right optic disc edema, obscuration of surface vessels, and a superotemporal flame hemorrhage.