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A case of atypical disc edema

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A discussion on neuroretinitis ,Pseudo tumour orbit and Posterior scleritis pending for now,...

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A case of atypical disc edema

  1. 1. An ATYPICAL CASE OF DISC EDEMA (DUE TO POSTERIOR SCLERITIS) Dr Samuel Ponraj Post graduate Department of Ophthalmology MMC & RI
  2. 2. History Mrs Valli ,42 yr old ,Home maker Chief Complaints : Headache of left side - 1 week Diminshed vision of left eye - 1 week
  3. 3.  History of Presenting illness Complaints of sudden loss of vision of left eye for 1 week associated with headache ,dull character and left sided . Complaints of cough and cold for 2 days. No complaints of photophobia , floaters,diplopia,watering,frequent change of glasses,joint pains, skin rashes , fever. No complaints of weakness or sensory disturbance .
  4. 4.  Past history : History of intermittent pain and redness of left eye since 2 years which subsided after instillation of Ciplox – D eye drops in left eye . History of Hypertension - 6 months on treatment. History of contact with pet dogs for 2 years. Not a diabetic or Asthmatic.
  5. 5.  General Examination : Patient is cooperative,conscious, oriented Vital Parameters – Blood pressure : 130/80 mm/Hg Pulse : 84/min No Pallor ,Icterus, Cyanosis , Clubbing , Lymph node enlargement , Edema.
  6. 6. Ocular Examination  Head Posture – Normal  Gaze in Primary Position – Orthophoric  Facial Symmetry – Normal  Orbital Symmetry – Normal  Extra Ocular Movements – Full in both eyes
  7. 7. FUNDUS –RIGHT EYE EYE  LEFT
  8. 8. RED FREE FILTER RE LE
  9. 9. Ocular Examination 16/11/2013 Right Eye Left Eye Distance Vision 6/6 1/60 No improvement with pinhole Near Vision N6 N60 Eyelids NORMAL NORMAL Conjunctiva NORMAL NORMAL Cornea Clear Clear Anterior Chamber Depth Normal Clear Anterior Chamber Depth Normal Clear Anterior Chamber Iris Colour – Normal Pattern – Normal Colour - Normal Pattern - Normal Pupil Reacting briskly to light RAPD + Lens Clear Clear
  10. 10. RIGHT EYE LEFT EYE Colour Vision Normal Defective IOP 17.3 mmHg 17.3 mmHg Fundus Media – Clear Media – Clear Disc – Size – Normal Disc – Size - Normal Colour -- Normal Colour – Pallor Cup/Disc – 0.4 No Vessels - Normal hyperemia Fovea – Normal Margin - Blurry Peripapillary Edema Vessels – Normal Fovea – Edema Serous detachement few exudates + superior to macula
  11. 11. B scan of Left Eye
  12. 12. B Scan of left eye
  13. 13. Neurological Examination     Other cranial nerves – Normal Motor System - Normal Sensory System – Normal Cerebellar system – Normal Respiratory System Normal breath sounds heard No added sounds Cardiovascular System S1 ,S2 heard No murmur
  14. 14.  B Scan of Right Eye : Normal Left Eye : Vitreous Cavity – Normal Edema around Optic nerve head RC complex –thickened Macula – Serous detachment “ T” Sign present No Visible Orbital mass lesion.
  15. 15.  Differential Diagnosis - Posterior Scleritis - Idiopathic Orbital inflammatory disease - Optic Neuritis - Neuroretinitis - Vogt Koyanagi Harada Syndrome - Central Serous Chorio Retinopathy - Non Arteritic Anterior Ischaemic Optic Neuropathy - Hypertensive Retinopathy
  16. 16. Investigations : Hb : 8.6 gm % PCV : 29 % RBC : 4.27 million/cumm MCV : 68 fl MCH : 20 pg MCHC : 30 ESR : 39 after 1 hr TC: 12,300 cells/cumm N : 87 % E : 4 % , L : 9 % AEC : 492/cumm HIV : Non reactive VDRL : Negative Platelet : 4.85 lakh/cumm RBS :98 mg/dl ANA : negative RF : negative CRP : within limits Mantoux Test – Negative Chest X Ray – Normal MRI Brain - Normal
  17. 17.  Treatment started on 16/11/2013 Tablet Predmet 16 mg 2 – 0 – 2 Tablet Rantac 150 mg 1 - 0 – 1 Tablet Doxycycline 100 mg 1-0-1 x 1 week On review – 18/11/2013 Right Eye Left Eye Distance Vision 6/6 6/18 NIP Near Vision N8 N8 Pupil RTL RTL Fundus Normal Media –Clear Disc –Normal Vessels – Normal Fovea – Exudates present
  18. 18. FUNDUS – LEFT EYE
  19. 19.  Admission on 25/11/2013 Started on Inj IV Methyl Prednisolone 1 gm in 200 ml – 5 days and Mutltivitamins then was Discharged , Oral Tab Predmet 16 mg 2-0-2 Review after 1 week. Condition at time of discharge Left eye - Vision improved to 6/9 - Colour vision continued to be defective
  20. 20.  On Review following 2 weeks , Patient came with congestion in her left eye and a history of frequent use of steroids.

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