History
A 42-year-old black male presented for an eye examination with a chief complaint of blur for two weeks. His ocular and systemic history was noncontributory for disease but positive for trauma. He was hit by a car two weeks earlier and sustained several broken ribs in the accident.

Diagnostic Data
 His best uncorrected acuity was 20/25 O.D., 20/200 O.S. at distance and near. External examination found no extraocular muscle restriction and a positive afferent pupillary defect O.S. The anterior segment exam of both eyes was normal with no evidence of angle recession,

The patient had this fundus appearance and an afferent pupillary defect O.S.

hyphema, iritis or lens dislocation. Goldmann pressures measured 20mm Hg in both eyes.


Dilated fundoscopy of both peripheries was normal. Both optic nerves had cup-to-disc ratios of 0.55 x 0.55. The pertinent posterior pole finding O.S. is demonstrated by the photograph.

Your Diagnosis
Does this case require any additional tests? What is your diagnosis? How would you manage this patient? Whats the likely prognosis? To find out the answers to this months column, click here.