Girl referred for visual field defect, ‘heavy’ sensation behind eye

A 13-year-old girl was referred from an outside ophthalmologist with a complaint of a “gray line going straight through” the visual field in her left eye that began 2 days before presentation. One day before presentation, she began having a “dull, heavy” sensation behind her left eye, with a severity of 8 out of 10, as well as expansion of her visual field defect peripherally, described as “the gray blob spread.”On presentation, she described her pain as “minimal” but noted her vision still remained very poor. She denied any prior episodes. Review of systems was remarkable for an episode of neck stiffness and headache. Her primary care physician treated the neck stiffness with topical anesthetic for presumed muscle strain, and the neck stiffness and headache resolved within days. She also noted bruising along the vertebrae on her back approximately 1 week before presentation. She denied any fevers, numbness, tingling or weakness.