LA is a 50-year-old man who presented with complaints of a rapid reduction in vision and moderate aching pain over the past 24 hours. He denied any previous history of a similar event. His past medical history was positive for a seizure disorder and a recent increase in vascular headaches. He had taken two doses of topamax starting 2 days previously. Clinical examination found visual acuity in both eyes of less than 20/400 but this was improved to 20/70 OD with a −2.50 sphere and 20/80 OS with a −3.50 sphere. He had no history of wearing glasses or contact lenses. There was 2+ corneal edema bilaterally and intraocular pressures of 45 OD and 47 OS. The indirect ophthalmoscope could visualize the optic nerves with a cup to disc ratio of 2/10 OU.
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