I’ve Had a Constant Blur in My Right Eye for 6 Years

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A Caucasian female in her 40s

Chief Complaint

“I have had a constant blur in right eye for past 6 years. I have seen several doctors  over the years but they can’t seem to figure it out.”

Medical History


Ocular History

Glasses for distance


Vitamin B, Ocuvite, Ibuprofen, Aspirin

Allergic to Penicillin

Family History

Mother – Cancer

Father – Diabetes, Cataracts

Social History

Social drinker

Diagnosis and initial plan of action

I didn’t get to see the patient so I didn’t have to worry about this. I work at a private practice on Saturdays, where one of the doctors had seen this patient.

Applicable Testing & Results of Testing

Distance visual acuity (uncorrected) – forgot to obtain this information from the doctor

Cover Test: Ortho

Confrontation fields: FTFC OU

Extraocular muscles: Full OU

Pupils: PERRLA, (-) APD OS; + APD OD

Manifest Refraction:

OD: -1.25 – 0.75 X 122 20/50

OS: 0.00 – 0.50 X 075 20/20

Add +2.25

Slit lamp examinationL

Lids/lashes, conjunctiva, cornea – clear OU

Anterior chamber – no cells or flare

Angles – open OD, unable to view OS

IOP – 12 mm Hg OU

Dilated fundus exam

Lens – Clear OU

C/D – 0.3/0.3 OU

ONH – complete pallor OD (see below picture), normal OD

Posterior pole / macula / periphery – normal OU

Visual Field – see pictures below

OD – severe depression of overall visual field

OS – localized visual field defect


Assessment and Plan

The patient had primary optic nerve atrophy with an unknown etiology. Since the doctor didn’t know what had caused it or what was causing it, he referred the patient to neuro-ophthalmologist for further investigation. After running few tests such as MRI, the patient was diagnosed with sphenoid meningioma. She had a surgery to remove the tumor, which gave her vision back (20/20).  It is unfortunate that patient had blurry vision for so long and no one was able to help her.  She had even gone to a major hospital, where they had run the visual field but they missed it. The case just reminds us that if we can’t figure something out for a patient, we have to find answers or refer the patient to appropriate person to help them.

Little bit about sphenoid meningioma from The Massachusetts Eye & Ear Infirmary:

  • Benign, slow-growing tumor
  • Most commonly occurs in females with mediate age of 38 years old
  • Symptoms (depending on location) – proptosis, globe displacement, diplopia, decreased visual acuity and optic neuropathy
  • Treatment
    • Radiation is first line of therapy
    • Excision of the tumor if no useful vision remains


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