History/Chief Complaint

  • A 60-year-old Hispanic female presented with a sudden, painless loss of vision in her left eye upon awakening. She had no other common neurological complaints. Her general health history revealed systemic hypertension, treated with Benicar.

Clinical Findings

  • BCVA 20/25 OD 20/30 OS.
  • Ta = 28 OD 27 OS.
  • Gonioscopy open grade 2 OU.
  • Pupils 2+ Relative Afferent Pupillary Defect (RAPD) OS.
  • Motility: full with no pain on eye movements reported.
  • Fundus exam – slight disc blur left eye with spontaneous venous pulsation OU.


  • Optic Neuropathy OS of unknown etiology.


  • Referral to her internist for comprehensive workup.
  • Follow-up several days later for additional tests of optic nerve function and structure.
  • MRI of brain and orbits ordered.