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JAMA Ophthalmology Clinical Challenge |

Woman With Sudden Loss of Vision—Quiz Case

Vincent D. Venincasa, BS; Jayanth Sridhar, MD
JAMA Ophthalmol. 2013;131(4):531-532. doi:10.1001/jamaophthalmol.2013.304a.
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A 28-year-old woman of Irish descent with a history of seizures and high myopia with astigmatism developed sudden loss of vision in her right eye and headache the night before presentation. She reported no history of trauma. Her cardiac, social, and family histories were unremarkable. Best-corrected visual acuity was 20/300 OD and 20/40 OS, with intraocular pressures of 45 mm Hg on the right and 7 mm Hg on the left. On examination of the right eye, an anterior and inferior subluxation of the lens was noted, with pupillary block and corneal edema obscuring the view of the posterior segment (Figure 1 and Figure 2). Examination of the left eye revealed an inferior lens subluxation with broken zonular fibers superiorly and an unremarkable fun-dus (Figure 3). Physical examination revealed normal length digits, with no evidence of hyperextensibility, ardiac murmurs, or rash.

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Figure 1. Corneal edema and inferior lens subluxation in the right eye.

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Figure 2. Inferior lens subluxation in the right eye.

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Figure 3. Inferior lens subluxation with broken zonular fibers in the left eye.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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