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A 24-year-old woman with blurred vision and eye pain
Digital Journal of Ophthalmology 2008
Volume 14, Number 16
August 18, 2008
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Aristeidis Konstantinidis | Royal United Hospital Bath, UK
Ioannis Athanasiadis | Milton Keynes General Hospital, UK
Nikolaos Kozeis | Hippokarateio General Hospital , Greece
Claire Workmann | Coventry & Warwickshire University Hospital, UK
Yajati Ghosh | Coventry & Warwickshire University Hospital, UK
Examination
The patient was a high myope with best corrected visual acuity (BCVA) of 6/9 (20/60) in the right eye and 6/60 (20/200) in the left eye. Visual acuity did not improve with pinhole in either eye. On examination there was no relative afferent pupillary defect (RAPD) and both optic discs were normal. However, color vision (tested with Ishihara’s pseudo-isochromatic plates) was impaired in the left eye and normal in the right. Red desaturation was present in the left eye.

The neurological examination was normal. Visual field testing showed a diffuse reduction in sensitivity of the left eye with a dense centrocecal scotoma and a superior temporal quadrantanopia in the right eye (Figure 1), which was confirmed with a second visual field test on the following day (Figure 2). This pattern of defects is a junctional scotoma.
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Figure 1
Dense cecocentral scotoma with diffuse reduction of the sensitivity of the left eye associated with a superior temporal quandrantanopia in the right eye (junctional scotoma).

Figure 2
Similar junctional scotoma confirmed on the following day.