Painless vision loss.

Volume 90, Number 11 www.aafp.org/afp American Family Physician 791 A 42-year-old woman presented with gradually decreasing vision in her right eye that began five days earlier. She did not have chest pain, palpitations, headache, or other neurologic symptoms. She was taking lisinopril (Zestril), furosemide (Lasix), and carvedilol (Coreg) and had allergies to atenolol (Tenormin), hydrochlorothiazide, and codeine. She had a history of hypertension and tobacco use. Her blood pressure was 180/104 mm Hg, and her pulse was 112 beats per minute. Her body mass index was 33 kg per m2. Visual acuity was 20/400 in her right eye and 20/20 in her left eye. No afferent pupillary defect was noted. Intraocular pressure was 15 mm Hg in each eye. Confrontation visual field testing demonstrated a superior scotoma in her right eye and no defect in the left eye. Findings on anterior segment examination were normal in each eye. Retinal examination revealed intraretinal hemorrhages in the inferior half of the retina in the right eye with edema extending into the macula (see accompanying figure). The left optic nerve and macula were normal. Complete blood count, creatinine, and blood glucose measurements were normal.