Monocular Vision Loss in a Patient with Altered Mental Status

A 64-year-old male with a history of CRVO and Dry AMD presented to an ophthalmologic ED with severe, acute monocular vision loss OS for 7 days, preceded by two months of bilateral blurry vision, severe headaches, and bilateral peri-orbital pain worse with EOMs that interrupted sleep. The patient's past medical history also includes steroid-induced diabetes mellitus, systemic hypertension, ankylosing spondylitis, ulcerative colitis, and CKD, for which he underwent a kidney transplant 7 months prior and takes tacrolimus and oral prednisone. The history was also relevant for fatigue and weight loss, confusion, which had progressed over the previous week, incoherent speech, and right foot drop.