Sudden loss of vision at the gym

A woman in her 30s presented to the emergency department with sudden loss of vision in her right eye while doing squats and burpees during a workout at the gym. Initially, the vision in her right eye had become “pixelated,” after which she noticed a “black hole” in the centre of her vision (central scotoma). Her peripheral vision was preserved. She experienced migraines with aura but had no symptoms suggesting migraine during this episode. No other medical or ocular problem was reported and she was not taking regular medication. She quit smoking18 years earlier.

On examination, Snellen visual acuity was counting fingers on the right and 6/5 on the left, unaided. No relative afferent pupillary defect was detected. Both anterior segments were normal. Fundus examination of the right eye showed a boat-shaped pre-retinal haemorrhage overlying the macula (fig 1). No other retinal vascular or fundal abnormalities were detected. The fundus of the left eye …