June 2014 Wills Eye Resident Case Series

Not long after an uncomplicated delivery, a young mother experiences a sudden onset of blurry vision in both eyes.

Neil Vadhar and Alice Williams, MD
6/5/2014

Presentation

A 23-year-old female presented to the Wills Eye emergency department with a chief complaint of sudden onset blurry vision in both eyes. It began in her right eye approximately 15 hours prior to presentation and in her left eye 10 hours later. She also had many floaters and flashing lights in both eyes. She denied any headaches, double vision, transient obscurations of vision, dizziness, numbness or weakness.

Medical History


The patient was 10 days post-partum from an uncomplicated spontaneous vaginal delivery. Past medical history and ocular history were otherwise unremarkable. Prenatal vitamins were her only medication.

Examination

Ocular examination revealed a visual acuity without correction of 20/60 in the right eye and 20/70 in the left eye. There was minimal improvement with pinhole to 20/50 in both eyes. Her pupils were equal, round and reactive to light with no afferent pupillary defect. Her intraocular pressures were 16 mmHg in both eyes. Motility was full and visual fields were full to confrontation. Color plates were 3/8 in the right eye and 6/8 in the left eye.
 
Slit lamp examination of the anterior segment was unremarkable, and Shafer’s sign was negative in both eyes. Fundus examination revealed serous retinal detachments over the macula extending to the periphery in both eyes (See Figure 1).  The vitreous, optic nerve, and vessels were otherwise normal.


Figure 1. Fundus photos reveal bilateral subretinal fluid.




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