PUBLICATION EXCLUSIVE: Man presents with decreased vision after extubation

A 50-year-old African-American man with a medical history of hypertension, hyperlipidemia and renal cell carcinoma was transferred to Lahey Medical Center for decreased vision in his right eye during a prolonged hospital course. He recently had undergone a partial nephrectomy that was complicated by internal bleeding, wound dehiscence, bowel perforation and sepsis. He required two additional surgeries, and he remained intubated for 5 days. Several days after extubation, the patient noticed decreased vision in his right eye while undergoing hemodialysis. He also reported experiencing headaches and hearing intracranial noises. Additionally, he developed significant pain at the site of his right internal jugular hemodialysis catheter. He denied any ocular pain at the time.Uncorrected visual acuity was count fingers at 2 feet in the right eye and 20/25 in the left eye. The right pupil was minimally reactive to light while the left pupil constricted briskly to light. There was a significant 3+ afferent pupillary defect of the right eye. IOP was within normal limits in both eyes. Confrontational visual fields revealed superior constriction in the right eye but no defects in the left eye. Extraocular movements were full in both eyes. The patient was able to identify none of the 10 Ishihara color plates in the right eye and 9 of 10 plates in the left eye.