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Case presentation 2
- A 50-year-old male presented with progressively diminishing vision in both eyes since childhood and sudden loss of vision in the right eye 20 days ago. Examination found high myopia, retinal detachment in the right eye, and mature cataract with total retinal detachment in the left eye. Investigations showed anemia. The patient was diagnosed with pathological myopia in both eyes, with retinal detachment in the right eye and cataract with retinal detachment in the left eye.
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Case presentation 2
- 1. CLINICAL CASE PRESENTATION Moderator: Dr.Umesh Harakuni Presentor: Dr. Arushi Prakash 08/07/’1 4
- 2. PATIENT PARTICULARS NAME: A.P. HospitalIn Patient No: 606236 AGE: 50 years SEX: Male RELIGION: Hindu ADDRESS: Belgaum OCCUPATION: Milk Seller
- 3. CHIEF COMPLAINTS • Progressivelydiminished vision in both eyes since childhood • Loss of vision in Left Eye since 5 years • Sudden loss of vision in Right eye 20 days ago
- 4. HISTORY OF PRESENTILLNESS • Patient presented to KLES with complaints- • Ever since he was a small boy he had a faulty vision as compared to his peers • Had diffculty in seeing blackboard • At the age of 10, he went to an ophthalmologist who prescribed him glasses of number. • Could see very clearly with those glasses 7
- 5. 25 • As hegrew older the number progressively increased and at last refraction 10 years ago was • With each subsequent refraction vision kept on progressively deteriorating • Since childhood patient has photophobia and experiences a little pain around eyes when direct light is put to his eye • He has difficulty in judging depth and distances • Since past 6-7 years patient has difficulty in seeing at night.
- 6. • 5 yearsago patient started developing increased diminution of vision in Left eye and within a period of one month he could no more than appreciate light from the light eye • In the past 2-3 years he developed some black and blue spots in front of his right eye, which moved as he moved his eyes and persisted on closing the eyes also . Number of spots progressively increased. • Since 25 days the patient started seeing lighting flashes infront of right eye even when it was dark at night and there was no light in the room.
- 7. • 20 daysback, the patient had gone to sell milk in the morning, and could see properly, as he was collecting money in the afternoon, he experienced sudden darkness infront of his eyes and could not count money. • This loss of vision was so drastic that he did not even know how to go home • After further 10 days of this sudden onset diminution of vision, the patient went to Ramkrishna Mission Ashram and was referred to KLESH for further evaluation
- 8. • No historyof- Redness of eyes Tufts of hair or cobwebs infront of eye Sudden shower of red spots in front of eye Excessive lacrimation Diplopia Ocular pain or headache Recent trauma to the eye or head
- 9. Physical straining orstress Ocular surgery (cataract, squint, removal of any growth)
- 10. PAST HISTORY • Nohistory of similar complaints in the past • 10 years ago, while walking down the stairs carrying a heavy weight object the patient fell and sustained injury to the left side of his head, above the left eye and on the chin for which sutures had to be put on the chin. Patient says he experienced no immediate deterioration of vision from this incident. • While working night shifts in a plastic factory some 25 years ago, the patient often experienced night time chills which he attributes to an allergy to some material in the factory and which later stopped.
- 11. PAST HISTORY • Historyof easy fatigability since past 6 months which has been progressively increasing No history of – • Prolonged illness • Chronic Cough • Breathlessness • Diabetes • Hypertension • Haemoptysis • Malena
- 12. Joint pains Chronic drugintake Previous hospital admission
- 13. PERSONAL HISTORY • Diet- Vegetarain • Appetite – Markedly reduced • Sleep pattern - Disturbed • Bowel/Bladder habits - Unaltered • Addictions- Non smoker/ non drinker No history of use of any recreational drugs
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- 15. FAMILY HISTORY • Patientwas born of a consaginous marriage • Has 4 siblings and is third order child • Neither parents nor any of the siblings had a similar complaint • Younger brother was prescribed glasses at the age of 16 years, which after few subsequent refractions are now of number since few years • None of the parents or the other three siblings had any history of spectacle use 10
- 16. FAMILY HISTORY • Patient’sfather died at the age of 90 of natural causes • Patient’s mother is 80 years old and suffers from only age related degenerative changes • All of the patient’s siblings are alive and healthy • He has a 10 year old son who goes to school, does not wear glasses and has no ocular complaints.
- 17. GENERAL PHYSICAL EXAMINATION •Patient is a middle aged male, moderately built poorly nourished man. • He is conscious, cooperative and well oriented to time, place and person. • Temperature – Afebrile to touch • Pulse - 70 beats/min • Respiratory Rate - 22 cycles/min • Blood Pressure – 110/70mmHg (in right arm supine position)
- 18. • Pallor ++ •Cheilosis + • Loss of papillae on tongue • Poor dental hygiene • Koilonychia + • He exhibits no evidence of • Icterus • Clubbing • Cyanosis • Lymphadenopathy • Edema
- 19. SYSTEMIC EXAMINATION •Cardiovascular system Oninspection- Distended neck veins present On Palpation- Apical impulse cannot be palpated Ausculation- Normal S1 and S2 heard in the mitral, tricuspid and aortic areas with no evidence of any murmurs
- 20. SYSTEMIC EXAMINATION In Pulmonaryarea a soft extrasystolic murmur is present, best heard in sitting posture with breath held in expiration
- 21. SYSTEMIC EXAMINATION • Respiratorysystem Bilaterally equal air entry on both sides. Normal vesicular sounds heard on auscultation. No adventitious sounds heard.
- 22. SYSTEMIC EXAMINATION • PerAbdomen All 4 quadrants on palpation are soft, non tender. No evidence of organomegaly present. Normal bowel sounds heard.
- 23. SYSTEMIC EXAMINATION • CentralNervous System Higher mental functions intact. No focal neurological deficit.
- 24. Ocular examination : •Head posture is erect • Facial symmetry maintained • Ocular posture – 30° of exotropia in left eye • Extraocular movements : • Oculus dexter Oculus uterque Oculus sinister N N N N N N N N N N N N N N
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- 27. Visual acuity • ColourVision could not be assesed Right eye Left eye UCVA HMCF PL +ve PR accurate PL +ve PR innacurate With pinhole No improvement No improvement Near Vision <N36 <N36
- 28. Retinoscopy : (withTropicamide dilatation at 1m distance ) -24.0 No glow • -24.0 Oculus Dexter Oculus sinister
- 29. • Patient doesnot acccept any subjective correction.
- 30. INTRAOCULAR PRESSURE (withSchiotz) RIGHT EYE LEFT EYE 12.2 mmHg Unrecordably low Visual Fields • Could not be assessed
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- 33. A Scan 08/22/15 RIGHT EYELEFT EYE K1 44.50 D 43.75 D K2 45.00 D 44.50 D Axial Length 27.08 mm 25.08 mm AC average 3.61 2.70 PCIOL +10.00 D +15.50 D
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- 36. 08/22/15 36 Investigations • Hb –04.8 gm% • TLC – 8,400 cells/cmm • DLC – N 69, L 26, E 03, M 02 • ESR – 66 mm at the end of 1hour • PCV – 16.3 % • Platelet count – 5.4 lakhs/cmm • Absolute Eosinophilic Count- 225 • Reticulocyte Count- 0.1
- 37. • RBC count-3.19 million/ cmm • Peripheral smear- Microcytic hypochromic anaemia, anicocytosis, pencil cells, tear drop cells and polychromatophils with thrombocytosis • Blood Group – A positive
- 38. 08/22/15 38 • Mini renal SerumUrea – 23mg/dl Serum Creatinine – 0.6 mg/dl
- 39. 08/22/15 39 • Liver FunctionTests ▫ Total bilirubin - 0.8 mg/dl ▫ Direct bilirubin - 0.2 mg/dl ▫ Total protein - 6.6 g/dl ▫ Serum Albumin – 3.3 g/dl ▫ A:G Ratio – 1.0 ▫ SGOT – 28 IU/L ▫ SGPT – 10 U/L
- 40. OCULAR DIAGNOSIS • PathologicalMyopia with Right Eye Rhegmatogenous Retinal Detachment with Choroidal Detachment and Left Eye Senile Mature Cataract with Total Retinal Detachement