Purpose: To report a case of paracentral acute middle maculopathy (PAMM) in an otherwise healthy adult with a patent foramen ovale (PFO). Case summary: A 38-year-old male with no significant medical history presented with acute onset vision loss (20/60) in the right eye. PAMM was diagnosed based on the following findings: hyperreflective band-like lesions at the level of the inner nuclear layer on spectral- domain optical coherence tomography (OCT) and dendritic blacked out areas of hypoperfusion in the intermediate capillary plexus layer on OCT angiography. A systemic workup revealed a large PFO suspicious as a secondary underlying abnormality. After successful closure of the PFO, the pericapillary ischemic signs at the macula were resolved, and the patient’s visual symptoms significantly improved to 20/40. Conclusions: This report verifies the importance of an early cardiac investigation in otherwise healthy individuals with PAMM.