A 31-year-old Caucasian female presents with a 2 week history of acute onset of right eye pain followed 3 days later by subjective temporal field loss, blurriness of vision, and decreased color vision. The patient reports relatively severe pain with eye movements. Other history is not significant.
Examination showed best corrected visual acuity of 20/50 right eye and 20/20 left eye. Intraocular pressures and motility were normal. Pupil exam was positive for a right afferent pupillary defect (APD). Confrontation fields show temporal defect in right eye and full in left eye. Color vision testing was 11/15 plates in the right eye and 15/15 plates in the left eye. Ocular alignment demonstrated a small exotropia in all gaze positions. The slit lamp exam was normal. Dilated fundus exam revealed C/D of 0.1 in both eyes, mild nerve edema in the right eye, and a normal nerve in the left eye. Macula, vessels and periphery were normal in both eyes.