Presented on 24-3-13 at Baroda Ophthalmic Society

1. Neurological fields
Baroda Ophthalmic Society
March 2013

2. Case 1.

3. Case 1. Gradual Loss
M/55, 2003
DV 2 months, difficulty in reading
Stroke 4months, Squint

4. Case 1. M/55, 2003
V 6/9
Pupil brisk
V 6/9
IOP 13
Pupil brisk
IOP 14

6. Case 1: follow up 2009

7. Case 1. comparison 2003-2009

9. 20-5-06 RE Case 2. 20-5-06 LE

10. Case 2. Sudden Loss
M/38
ROAD ACCIDENT

11. Case 2.
Trauma 4/5/2006, UNCONCIOUS DV LE NOTICED LATER
6/9 6/36, nasally
Pupil brisk Pupil sluggish
IOP 11 IOP 14

12. 2007 2008

13. Case 2 follow up
• 19-11-2008: RE 6/9, LE 6/12
• LE PUPIL SLUGGISH
• 28-1-2010: LE 6/12, NEAR +1.5=N10

14. Case 3. Fields 27-11-09

15. Case 3.
M/50
22-8-2007
Dimness LE 6/24,
NS grade III
Hypertensive

16. Case 3
• IOP RE 17, LE 13
• Pupils reacting normally
• LE Phaco 14-9-07
• Post op 6/9 till 19-6-08

17. Case 3
• Head Injury on 16-8-09, left temporal region
• Reports loss of vision on 26-11-09.
• MRI for left optic canal, nerve, reported NAD
• Vision LE FC 2’
• IOP 16 OU

18. Case 3 Fundus 2-12-09

19. Case 3 LE
Naked Vessls
RNFL

20. Case 3. Sequence

21. Case 3 on 7-5-12
• RE 6/9
• LE upper half 6/12
• IOP 13 OU on Brimolol

22. RE Case 4: Fields 2009 LE

23. CASE 4 Gradual Loss
M/69
2009
DV FOR NEAR 3 MONTHS

24. Vision:
RE 6/18 (-1.0 -1.0 90*)
LE 6/18 (-1.0 -1.0 90*)
Cataract NS III
IOP 26 OU

25. CASE 4:
Severe episcleral venous congestion
CT SCAN NORMAL

26. Case 4: Disc Cupping

27. Case 4: Disc Cupping
• RNFL LOSS

29. Case 4:
• RE Phaco + Trab on • LE phaco + Trab on
• 8-3-2011 • 4-2-2010
• IOP 12 with topical • IOP 13 with topical
drops drops

30. Case 4: Follow up
RE 6/9

31. IOP
RE 12
LE 13

32. Glaucoma +
?Cavernous
sinus

34. Case 5

35. CASE 5

36. Case 5
• F/65, 19-5-12, dimness 1 year
• Hypermetrope, OU +1.5=6/9,
• Advanced cupping L>R
• IOP 15, 13 without treatment
• Pupils RE brisk LE Sluggish

37. Optic Disc

38. Fields 25-5-12
IOP
RE 16
LE 14
TRAVACOM
MRI
FEW CH ISCHEMIC FOCCI
BILAT. FRONTO-PARIETAL
PARIETO-OCCIPT

39. Fields 12-12-12
IOP
RE 13
LE 15
TRAVACOM
ADD BRIMO

40. Fields 22-3-13
IOP
RE 15
LE 15
CCT
RE 539
LE 544

41. Fields comparision

42. Case 5: SIGNIFICANT CUPPING IN
HYPERMETROPE

43. Case 6: Sudden Loss
20-10-04
M/43
Vision RE 6/9
LE FC 6’

44. Case 6
2005

45. Perimetry done elsewhere in July 2004
Medmont cluster analysis

46. Case 6 20-10-04

47. Case 6: LE Field 20-10-04

48. Case 6: came again on 24-2-2005
• Vision RE 6/12, LE 6/36
• Pulpil RE Brisk, LE Ill Sustained

49. Multiplesclerosis

50. Case 6:
Last followup 4-3-2005

51. Case 7 (2003)

52. Case 7: Gradual loss
24-6-1999
F/42

53. Case 7: History
• Dimness RE 8 months
• Diagnosed Optic Atrophy elsewhere
• NIDDM
• Vision RE FC 4’, LE -2.5 90*= 6/18
• Pupil RE Sluggish, LE Brisk

54. Case 7: Fundus Pictures

55. • Treated with Inj Methyl Pred IV.

56. Case 6: 22-07-2003

63. Types of Neurological defects
CENTRO-CAECAL
HEMI- QUADRANT ANOPIA
GLAUCOMA + NEUROLOGICAL FIELD LOSS

64. 25 cases with documented
neurological fields

67. •Case 3

68. Case 3: F/50 MAY 1993
DV GRADUAL 1WEEK HEADACHE VOMITING 2DAYS

70. Case 3: Follow up 2005

71. CASE 3: Follow up 2012

73. • MACULAR DEGENERATION
• GLAUCOMA
• MACULAR HOLES
• RETINITIS PIGMENTOSA
• HEMIANOPIA
• CHORIORETINITIS
• CONE DYSTROPHES
• BEST'S DISEASE
• STARGADT'S DISEASE
• ACHROMATOPSIA
• LEBER'S OPTIC ATROPHY
• Ischemic optic neuropathy
• Optic neuritis
• Occipital lobe tumours
• Pituitary adenoma
• Other Causes: V