Case report

A 30-year-old African–American woman began to experience transient visual loss in the right eye 3 days before presentation on 15 February 1988. These episodes lasted from one to several minutes and consisted of flashing lights, grey-outs and episodes of no light perception (NLP) vision relegated solely to her right eye. She did not experience headache, diplopia or any other focal neurologic phenomena. A total of 8–10 of these episodes had been experienced in the previous 3 days. Concomitantly, she had experienced anorexia and abdominal tenderness without fever, chills or other constitutional symptoms. She had no significant past medical or ophthalmologic history. She did experience migraines with her menses in the preceding 5 years. These episodes usually occurred just preceding or during menses, and were throbbing and associated with nausea without vomiting. The episodes were usually unilateral and mainly on the right side. These episodes could last for several hours or up to several days during the menstrual cycle. She did not experience migrainous aura. Her only medication was Ortho-Novum. She had presented to the retina clinic for evaluation while asymptomatic, and suddenly experienced painless vision loss to the NLP level in the right eye. Being immediately whisked to the neurophthalmology clinic, a 4+afferent pupillary defect was detected in the affected eye and the NLP vision corroborated. Examination of the fundus revealed obvious venous boxcarring indicative of a lack of arterial perfusion. The optic disc appeared pale in comparison with the disc on the left side. No definitive change in the calibre of the blood vessels could be ascertained (figure 1). With firm digital pressure, no arterial or venous pulsations could be induced indicating severe lack of arterial flow. A fluorescein angiogram revealed an almost immediate blush of the choroid, while the central retinal arterial circulation was grossly delayed (figure 2). Her visual acuity …