A 37-year-old female patient presented with sudden painless decreased vision in her left eye over 14 days, with no associated symptoms. Differential diagnoses include several retinal and optic nerve conditions, while her medical history reveals previous eye trauma and ongoing dyspepsia. Examination showed visual acuity discrepancies, particularly in her left eye, with findings of serous elevation in the macular area during fundus examination.

1. LONG CASE
PRESENTATION
Dr. Muhammad Zeeshan

2. PRESENTING COMPLAINTS
A 37 years old female patient presented with sudden
painless decreased vision in Left Eye since 14 days which
was severe at first, non-progressive, not associated with
any other symptoms like headache.

3. QUERY ?
What could be the Differential Diagnoses in this scenario?

4. DIFFERENTIAL DIAGNOSES
• Central serous chorioretinopathy
• Central retinal artery occlusion
• Central retinal vein occlusion
• Vitreous hemorrhage
• Retinal detachment
• Choroidal neovascular membranes
• Anterior ischemic optic neuropathy(arteritic, non-arteritic)
• Unilateral acute idiopathic maculopathy

5. PAST OCULAR HISTORY
There’s history of sharp pin injury to right eye 22 years
back resulting in traumatic cataract formation, for which
she was operated on.
There is no previous history of any use of spectacles or any
other significant ocular disorders.

6. PAST MEDICAL HISTORY
She gives an extensive 3-4 years history of dyspepsia and
similar abdominal symptoms for which she used Hakeem
medications.
She also gives history of on & off depressive episodes due to
some undisclosed extremely personal reasons.
Patient is non-smoker, normotensive and normoglycemic and
gives no history of any other systemic disease or drug usage.
Her last pregnancy was 4 years ago.

7. FAMILY HISTORY
Insignificant

8. SOCIAL HISTORY
Patient is a housewife and mother of 4.
She is non-smoker, non-addict.

9. DRUG/ALLERGY HISTORY
She is not allergic to any topical or systemic medication.

10. EXAMINATION
Visual Acuity is
OD  6/24 P.H  6/9
OS  6/36 P.H  6/36
Near Vision intact in right eye.
Color Vision intact for right eye while it is faulty for left eye.
Amsler Grid couldn’t be performed as patient’s pupils are
pharmacologically dilated.

11. EXAMINATION
On Torch examination:
Patient is orthophoric and pupil examination shows no
RAPD.

12. EXAMINATION
On Hand examination:
EOM full in both eyes , no deviation of eye on cover/uncover
test.
No abnormality of visual field on confrontation.
IOP also normal digitally in both eyes.
Corneal sensations and cranial nerve exam intact.

13. DIRECT OPHTHALMOSCOPY
Red reflex: Normal in both eyes
Bilateral media clear.

14. SLIT LAMP EXAMINATION
Anterior Segment Examination:
Right eye: Pseudophakic with posterior capsular
opacification.
Left eye: Anterior segment within normal limits.
On Applanation Tonometry:
OD  12 mmHg
OS  15 mmHg

15. SLIT LAMP EXAMINATION
Posterior Segment Examination:
Right Dilated Fundus examination seems to be normal.
Left Dilated Fundus examination shows serous elevation of
retina in macular area measuring about 3 disc diameters.
Optic disc showed deep cup with Cup/Disc ratio of around
0.5. Rest of fundus seems to be normal.

17. THANK YOU