Sudden-Onset Monocular Blurry Vision in a Young Woman

A 32-year-old woman who was admitted to the hospital for fever, flulike symptoms, and altered mental status developed sudden-onset blurry vision in her right eye. Her history was notable for phthisis in her left eye due to a left orbit clear cell sarcoma with metastatic disease, after surgical excision and radiation, with recent enrollment in a palliative immunotherapy research protocol. After completing 2 days of broad-spectrum intravenous antibiotics and antivirals for presumed septic meningitis, her laboratory and imaging results returned negative and she was transitioned to intravenous methylprednisolone (1 mg/kg). One day later, her mental status improved, and she reported central blurry vision in her right eye. On examination, her visual acuity was 20/40 in this eye, she had normal intraocular pressure, and there was no evidence of anterior chamber or vitreous cells. Dilated fundus examination revealed segmental areas of venous sheathing (Figure 1A) in the right eye and was not possible in the left eye owing to phthisis. An optical coherence tomography scan of the right eye revealed hyperreflective changes along the outer plexiform and outer nuclear layers, small intraretinal cysts, and disruption of the ellipsoid and especially the interdigitation zone (Figure 1B).