Sudden Fixed Swirl Circles in the Vision of a Young Healthy Woman

A woman in her 20s was referred by the optician to our acute and emergency department for suspected optic neuritis in the right eye. She reported a sudden onset of photopsia and visual disturbances described as “fixed swirl circles” in the central vision of both eyes noticed on awakening 5 days prior and persisting since that time. Her medical history included migraine and polycystic ovaries. She had a flulike episode 1 week prior to the onset of symptoms. The patient was taking oral contraceptives and denied the use of recreational drugs. Ocular movements were full but the patient reported pain and discomfort during movements of the right eye. Pupils were equal and reactive to light and there was no afferent pupillary defect. Best-corrected visual acuity was 20/20 OU; color vision was 17/17 OU on Ishishara plates. The anterior segment was unremarkable and intraocular pressure was 14 mm Hg in both eyes. Dilated fundus examination revealed a healthy optic disc and no obvious abnormalities at the macula of both eyes. Near-infrared reflectance imaging and spectral-domain optical coherence tomography (OCT) scans of the right eye are shown in the Figure.