Patient with unilateral loss of vision found to be wearing wife's spectacles

BMJ Case Reports authors have highlighted the cost of making assumptions after a man in his 80s with unilateral vision loss underwent a series of urgent investigations before he was found to be wearing his wife’s spectacles.

Clinicians from the Tennent Institute of Ophthalmology in Glasgow shared that a male patient in his 80s presented to the accident and emergency department with a sudden deterioration of vision in his left eye.

He had a history of diabetes, hypertension, dementia and glaucoma. A central retinal vein occlusion in his right eye meant that his vision in that eye was limited to counting fingers.

“The vision assessed with glasses at the time of presentation was counting fingers in both eyes and a neurological assessment was normal,” the authors shared.

Routine blood tests and a CT head scan were normal. After the stroke team requested an ophthalmic review, a pinhole test of the patient’s left eye revealed a visual acuity of 6/36.

“On further enquiry, his son declared he was in possession of multiple pairs of glasses found at the patient’s home and that the patient was currently wearing his wife’s glasses. When the correct glasses were sourced, his visual acuity improved back to his usual normal vision of 6/9 with resolution of all his visual symptoms,” the authors shared.

The clinicians emphasised that a pinhole aperture is a rapid and safe way of assessing vision.

“Using the simple pinhole test could have avoided extensive investigations and their subsequent costs,” the authors shared.