A 44-year-old Caucasian woman presented with sudden awarenessof painless vision loss in the left eye while driving. Physical examina-tion revealed visual acuity of 20/20 in the right eye and 20/60 in theleft eye, and there was a left relative afferent pupillary defect. Thefundus exam was notable for bilateral temporal optic disc pallor, leftgreater than right (Fig. 1). Automated static perimetry (Humphrey 24-2) revealed a left junctional scotoma (Fig. 2). The patient subsequentlyunderwent magnetic resonance imaging, which showed a 2.7 X1.7 × 1.7 cm suprasellar arachnoid cyst compressing the left posterioroptic nerve and anterior optic chiasm (Fig. 3). The patient underwentuncomplicated endoscopic trans-sphenoidal fenestration of the ara-chnoid cyst with recovery of her visual acuity to 20/20 in each eye andsubstantial improvement of her visual fields defect (Fig. 4).
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