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Patient presents with vision complaints
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A 58-year old woman presents to your office complaining of loss of vision. She claims that two days ago, she suddenly noticed loss of vision on the right side or the right eye. She saw something black on the right side for a few minutes and then saw some shimmering lights. The symptoms resolved within 15 minutes.
Her history is not very clear and you cannot ascertain whether the problem is with her eye or her right visual field. What is your next step?
Responses:
choose any, all or none
Step One
When approaching transient visual loss it is important to discern on history whether it is affecting one eye, or both. Monocular visual loss is due to a lesion anterior to the optic chiasm or within the eye itself, binocular (ie homonymous) visual loss localizes to the optic radiations or the visual cortex. It is important to ask about associated symptoms such as headache - given the history of scintillations, a migraine aura is a possible cause.
It is absolutely essential to examine visual acuity in each eye for any visual complaint.