Acute visual loss after initiation of antihypertensive therapy: case report

Abstract

We report the case of a 50-year-old man who reported sudden, painless loss of vision in his left eye after starting antihypertensive therapy. Potential causes of acute painless unilateral visual loss are discussed, as is the initial management of hypertension in asymptomatic patients.

Fig. 1: Left: Normal appearance of right eye on funduscopic examination. Right: Cherry-red spot in left eye with extensive retinal edema and pallor secondary to retinal artery occlusion. The foveal region appears cherry red because the surrounding retina is edematous and appears white, thereby accentuating the normal red foveal reflex coming from the choroidal circulation. Choroidal circulation is usually unaffected in central retinal artery occlusion.

Fig. 2: Fluorescein angiograms, taken several minutes after infusion of contrast medium. Left: The vasculature of normal right eye demonstrated early filling and passage of dye. Right: The left eye showed markedly delayed passage of fluorescein, with filling of its arterial tree beginning several minutes after the infusion.