LAUSR

A healthy 24-year-old female presented with sudden painless decrease in vision in the lower right quadrant of her left eye after awakening from her nap that afternoon. She was well, apart from an episode of dizziness after bathing during the previous 2 weeks. ,e episode had started 1 week after the patient had got acute tonsillitis. She denied associated symptoms of headache, fever, recreational drug abuse, and any other medical history. Examination of the affected eye revealed a vision of 20/ 20. Anterior segment examination was unremarkable in both eyes. Dilated fundus exam of the left eye demonstrated a region of retinal edema along the supertemporal arcade extending just above the macula. Confrontation visual field revealed a loss of inferior visual field in the left eye. ,e fundus photograph and fluorescein angiogram from the day after presentation are shown in Figure 1. An optical coherence tomography showed supertemporal inner retinal edema and visualized the intra-arterial embolus, as shown in Figure 2. Her retinal appearance and symptoms prompted referral to the cardiology team, which admitted her that day. Urgent erythrocyte sedimentation rate, C-reactive protein, and complete blood count were all normal. However, the transthoracic echocardiography revealed moderate-to-severe aortic valve regurgitation, with thickening and sign of vegetation, as shown in Figure 3 [3]. Blood cultures yielded Streptococcus viridans. ,e patient was diagnosed with infective endocarditis, and intravenous antibiotics were started immediately. Her visual symptoms subsided after medical treatment. ,e supertemporal retinal edema had completely resolved. Confrontation fields showed improvement in the prime inferior visual field defect of the left eye. Optical coherence tomography line scan showed no hyper-reflectivity. Her left fundal appearance and fluorescein angiogram after 4 weeks is shown in Figure 4.