Systemic Disorders With Optic Nerve and Retinal Findings

This 74-year-old asthmatic male had acute visual loss OS while watching the Super Bowl in 1994. He was seen the next day by a retina specialist, who noted that his optic disc was normal and referred the patient to a neuro-ophthalmologist, who evaluated him about 40 hours after his visual loss. He was 20/20 OD, 20/200 OS, with dyschromatopsia OS, and a 0.9 log unit relative afferent pupillary defect OS. The field showed generalized constriction with relative central sparing, and there was no swelling of the optic disc. He did, however, demonstrate evidence of lobular choroidal nonperfusion, and his fluorescein confirmed marked hypoperfusion of the choroid. He had constitutional symptoms of headache, malaise, polymyalgia rheumatica, and jaw claudication, and his ESR = 74. He was given 3 days of Solu-Medrol 250 mg q6h; the temporal artery biopsy was positive, and he recovered his vision to 20/25. Pair with 95_48, 95_49, 95_50, and 95_52.