59-year-old Woman with Acute Blindness

When a patient with acute blindness presents to the emergency department (ED), the evaluation typically suggests one of the “can’t miss” diagnoses ingrained in emergency physicians during training. How does the differential change when the patient’s presentation does not neatly reveal an expected pathology? A 59-year-old woman presented to the ED with acute binocular blindness in the setting of three days of a flu-like illness. This case offers a practical approach to opening the lens on the presentation of acute blindness.