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Reminder of important clinical lesson
Sudden loss of vision in a patient with significant ipsilateral internal carotid disease
  1. Farhad Huwez1,
  2. Udayaraj Umasankar1,
  3. Edward Casswell2,
  4. Jay Menon1,
  5. Narasimha Gadi1
  1. 1Medicine for Older People, Basildon & Thurrock Hospitals NHS Foundation Trust, Basildon, UK
  2. 2Department of Surgery, Basildon & Thurrock Hospitals NHS Foundation Trust, Basildon, UK
  1. Correspondence to Dr Farhad Huwez, farhad.huwez{at}


A 74-year-old man developed sudden onset of painless persistent partial loss of vision in the right eye 3 days after right total knee replacement. The initial investigation was for amaurosis fugax with a normal CT scan of the brain but the carotid Doppler confirmed >90% stenosis of the right internal carotid artery. Urgent ophthalmological review confirmed anterior ischaemic optic neuropathy. Subsequently, he lost his vision completely in the right eye. He had a previous high risk hemispheric transient ischaemic attack with carotid Doppler reported as normal.

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  • Competing interests None.

  • Patient consent Obtained.

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