A 68-year-old woman with a history of diabetes mellitus type 2, depression, and migraines presented with painless, acute, consecutive vision loss affecting the right eye for 1 week and the left eye for 2 weeks. Neuro-ophthalmic examination was notable for visual acuities of finger-counting peripherally, a central scotoma, anterior uveitis, vitritis, and placoid macular pigmentary changes in each eye (OU). Proprioception was diminished in the bilateral lower extremities. Optical coherence tomography (OCT) revealed hyper-reflectivity and attenuation of the outer retina OU with normal inner retinal architecture and reflectivity. Fluorescein angiography (FA) demonstrated normal filling of the central retinal arteries with patchy choroidal perfusion in the right eye and targetoid punctate foci of leakage in the macula OU. Before the recognition of intraocular inflammation and findings on OCT and FA, the patient was treated for presumed central retinal artery occlusion at an outside hospital. Additional diagnostic testing at our institution revealed an alternate diagnosis. This case highlights a rare presentation of a well-known disease entity and underscores the importance of avoiding diagnostic anchoring in clinical practice.

一名 68 岁女性，有 2 型糖尿病、抑郁症和偏头痛病史，出现无痛、急性、连续视力丧失，影响右眼 1 周、左眼 2 周。神经眼科检查值得注意的是每只眼睛（OU）的周边手指计数视力、中央暗点、前葡萄膜炎、玻璃体炎和鳞状黄斑色素变化。双下肢本体感觉减弱。光学相干断层扫描 (OCT) 显示外层视网膜 OU 的高反射率和衰减，而内层视网膜结构和反射率正常。荧光素血管造影（FA）显示视网膜中央动脉正常充盈，右眼有斑片状脉络膜灌注，黄斑 OU 中有靶样点状渗漏灶。在确认眼内炎症以及 OCT 和 FA 发现之前，患者在一家外部医院接受了疑似视网膜中央动脉闭塞的治疗。我们机构的额外诊断测试揭示了另一种诊断。该病例凸显了一种众所周知的疾病实体的罕见表现，并强调了在临床实践中避免诊断锚定的重要性。