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Older Man With Visual Symptoms of Acute Onset

Older Man With Visual Symptoms of Acute Onset

For more than a week, a 74-year-old man has had diminished vision in his left eye. He reports that the problem started acutely with a sensation of flashing lights in the affected eye, followed by the presence of dark floaters for several days. He initially had minimal vision loss in the lateral (temporal) field, but with each day the loss has become more profound and central; it now significantly impedes his ability to read and perform activities of daily living. He denies headaches or other neurological symptoms either before or during this episode.


The patient is relatively healthy for his age. He has had mild hypertension for about 10 years, which is well controlled with lisinopril, 10 mg/d; he has no history of coronary disease or diabetes mellitus. He sees an optometrist regularly and had a complete examination 4 months earlier, with no change in his eyeglass prescription.


Heart rate is 76 beats per minute; respiration rate, 14 breaths per minute; and blood pressure, 110/68 mm Hg. Eyes appear normal, without inflammation, and cranial nerves are intact. Funduscopy is deferred until consultation with an ophthalmologist. The remainder of the physical findings are normal.


A complete blood cell count and chemistry panel are normal. Total cholesterol level is 175 mg/dL, with a high-density lipoprotein cholesterol level of 62 mg/dL. Triglyceride level is 98 mg/dL.


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