13th August 2020

A 25-year-old Caucasian woman, who is an ex-smoker, presents to an ophthalmology clinic

A 25-year-old Caucasian woman, who is an ex-smoker, presents to an ophthalmology clinic with unilateral loss of visual acuity over the last 24 hours in her left eye. Her vision was initially cloudy and progressively worsened to the point that she can no longer see with her left eye. She reports associated retro-ocular pain. The patient also reports generalised weakness after prolonged walking, and she has noticed her foot dragging at times. On examination, her visual acuity cannot be assessed in the left eye with a Snellen chart and is restricted to hand movements with a large, central scotomata. The right eye is 20/20 with no visual field defects. Optic discs are normal bilaterally. Eye movements elicit pain in the left eye and relative afferent pupillary defect is present on the left. What is the most likely diagnosis considering her ophthalmological presentation?

For the patient above, please select the most appropriate diagnosis. Select ONE option from the list above.