Silent Stroke Presenting as Left Homonymous Hemianopia in a 42-Year-Old Male with Type 2 Diabetes Mellitus

Background: Silent cerebral infarctions are increasingly recognized as underdiagnosed contributors to cognitive and visual disability. Ophthalmologists often play a pivotal role in identifying subtle neurological deficits such as homonymous hemianopia. Case presentation: We report a 42-year-old male, chronic smoker and alcoholic with poorly controlled type 2 diabetes mellitus, who presented with complaints of difficulty in vision and mild eyeache on the left side. Ocular examination revealed best-corrected visual acuity of 5/60 in the right eye and 6/18 in the left eye. Fundoscopy demonstrated scattered dot-blot hemorrhages. Perimetry showed left homonymous hemianopia. MRI brain revealed right parieto-occipital gliosis consistent with an old ischemic insult, establishing the diagnosis of a silent stroke. Management and outcome: The patient was referred to neurology, started on dual antiplatelet therapy, strict glycemic control, and advised lifestyle modification. On follow-up, hemorrhages had resolved and visual field defects showed partial improvement, though left hemianopia persisted. Conclusion: This case highlights the importance of ophthalmological evaluation in detecting silent cerebral infarctions. Homonymous hemianopia in relatively young patients with systemic risk factors such as diabetes, smoking, and alcohol use warrants prompt neuroimaging and interdisciplinary management.