A 50-year-old woman who has had mild myopia for decades comes to the office for a routine physical examination.  The patient has no chronic medical conditions and eats a healthy diet consisting of a variety of organically grown foods.  She is excited because she rarely has to wear glasses or contacts anymore.  Her visual acuity at 20 feet is 20/30 in both eyes without wearing her glasses.  Which of the following conditions has the same etiology as the changes causing this patient’s visual improvement?

A 30-year-old man comes to the emergency department due to left eye pain after being involved in a street fight.  He received a fist blow to the left eye and has since had pain and diplopia.  Past medical history is notable for 2 previous gunshot wounds.  The patient does not smoke cigarettes but has a history of heavy alcohol intake and frequent marijuana use.  On examination, there is significant soft tissue swelling around the left eye.  Visual acuity is normal, but extraocular motility of the left eye is limited.  Pupillary reflexes are normal.  Coronal CT scan of the orbits is shown in the image below.

The orbital contents of this patient are most likely to herniate into which of the following sites?

A 34-year-old woman comes to the office due to double vision.  The patient first experienced difficulty focusing her eyes while at work yesterday.  On awakening this morning, her symptoms had progressed to frank diplopia.  Medical history is insignificant.  A complete physical examination is performed, including a full neurologic assessment.  Shining light into the patient’s right eye causes constriction of her right pupil, but not the left pupil.  Shining light into her left eye causes constriction of only her right pupil.  Which of the following additional physical examination findings is likely to be found in this patient?

A 3-month-old boy is brought to the office by his mother for a routine checkup.  He is found to have a right-sided white pupillary reflex.  His father was diagnosed with a retinal neoplasm during childhood and had his left eye enucleated.  This child is at the greatest risk of developing which of the following neoplasms?

A 31-year-old woman comes to the office due to transient visual changes that are characterized by “loss of vision for a minute” and commonly precipitated by bending forward or lifting objects.  During the last 3 months, she has had persistent headaches that she attributes to migraines.  The patient takes over-the-counter analgesics as needed.  Blood pressure is 140/90 mm Hg and pulse is 72/min and regular.  BMI is 32.4 kg/m².  Funduscopic findings of the left eye are shown in the image below, with similar findings in the right eye.

Which of the following is the most likely cause of the observed funduscopic findings in this patient?

A 43-year-old man comes to the emergency department due to painless, progressive visual impairment.  The patient was diagnosed with sexually acquired HIV infection 4 years ago.  He was previously started on antiretroviral therapy but has been noncompliant with his prescribed medications.  His most recent CD4 count was 37 cells/mm³.  Physical examination shows no skin rash or corneal lesions.  Funduscopy reveals the findings seen in the image below.

Which of the following medications is the best initial therapy for this patient?

A 64-year-old man comes to the emergency department due to painless loss of vision in the right eye.  The patient’s symptoms started suddenly several hours ago and have persisted.  He has had no trauma or any similar episode in the past.  He has a history of coronary artery disease, atrial fibrillation, and type 2 diabetes mellitus.  Blood pressure is 144/86 mm Hg and pulse is 92/min.  Cardiovascular examination reveals irregularly irregular rhythm with no murmurs, no peripheral edema, and slightly diminished pedal pulses in both feet symmetrically.  Visual acuity in the right eye is hand motion only and normal in the left eye.  Funduscopic examination of the right eye is shown in the image below.

Which of the following is the most likely cause of this patient’s loss of vision?

A 62-year-old man with a history of poor medical follow-up comes to the office due to difficulty seeing.  He has had blurry vision for the last 2 weeks.  A day ago, he noticed a shadow develop suddenly across the visual field of his right eye.  The patient has had no recent headaches, double vision, vertigo, light sensitivity, or nausea.  On examination, pupils are equal and reactive to light.  Visual field testing by confrontation reveals patchy loss of vision.  A flame-shaped retinal hemorrhage in the right eye is noted on funduscopic examination, as shown in the image below.

Which of the following is the most likely cause of his visual disturbance?

A 68-year-old woman is evaluated for vision impairment.  The patient has a decrease in both distant and near vision and has had occasional floaters.  She has had no pain or redness in her eyes, headache, focal weakness, or sensory loss.  Medical history is notable for type 2 diabetes mellitus, hypertension, and chronic kidney disease.  Blood pressure is 138/84 mm Hg and pulse is 76/min.  The pupils are equal and reactive to light bilaterally.  Anterior chambers are clear, and there are no opacities of the cornea or lens.  Funduscopic examination reveals scattered retinal microaneurysms, dot-and-blot hemorrhages, and cotton-wool spots, as well as new blood vessel formation.  Which of the following contributed most to the pathogenesis of this patient’s current ocular condition?

A 67-year-old smoker comes to the office with a 2-week history of decreased vision in his right eye that he describes as “blurry” and “distorted.”  The patient has been having vision problems over the past year, and these have made it more difficult to drive and require that he use a bright light to read the newspaper.  He has no history of diabetes mellitus or hypertension.  The patient uses an albuterol inhaler for occasional wheezing and shortness of breath.  Ophthalmologic examination of the right eye shows a grayish discoloration of the macula with areas of adjacent hemorrhage.  Which of the following should be specifically targeted in treatment of this patient’s condition?