A 76 year-old woman presented to the Emergency Department with sudden onset vision loss in the right eye. She has been otherwise well, her only other complaint is recent onset of a left-sided headache a few days preceding her vision changes. Her medical history is significant for hypertension and dyslipidemia, for which she takes amlodipine, hydrochlorothiazide and atorvastatin.
Examination reveals a well-looking individual in no distress, afebrile with blood pressure 142/86 and pulse of 78. Her best-corrected vision in the right eye is 20/30, hand motion in the left eye. There is a brisk left relative afferent pupillary defect. Slit lamp examination of the anterior segment shows only mild nuclear sclerosis of the lens. Fundoscopy is shown below.