A 21-year-old male patient complained of double vision and inability to see objects clearly, especially during lectures. Upon examination, his refraction showed high myopia in both eyes but no other abnormalities. The patient was prescribed glasses but remained unsatisfied. A dilated fundus exam revealed lens subluxation, which along with long, thin fingers, suggested an underlying diagnosis of Marfan syndrome. Marfan syndrome can cause lens subluxation and requires careful systemic review and dilated eye exams to properly diagnose and manage a patient's condition.

1. Interactive session; Image capture
By Dr. Pavly Moawad

2. Hello Dr… I am Adam , I am
21 years old..
I complain of being unable to
see objects clearly and
sometimes I see one thing
double .this makes for me big
problem during attending
lectures

3. • Upon examination of anterior segment , no
abnormality detected..
• Refraction of patient showed :
Right eye : -3.00/ -2.50 x 130
left eye : -4.00/ -3.00 x 90

4. • You prescribed the patient glasses and arranged
a date for follow up 1 week later..

5. Unfortunately the
patient wasn’t
satisfied with
glasses

6. • Dilated examianation of the patient showed:

7. • What can be the cause of lens subluxation ?

8. Did you notice patients hands ??

9. Marfan syndrome
• Marfan syndrome is a heritable disorder with ocular,
cardiac, and skeletal manifestations.
• From 50% to 80% of patients with Marfan
syndrome exhibit ectopia lentis .The lens
subluxation tends to be bilateral and symmetric
(usually superior and temporal), but variations do
occur.
• Spectacle or contact lens correction of the refractive
error can provide satisfactory visual acuity but in
many cases adequate visual acuity cannot be
obtained with spectacle or contact lens correction,
and removal of the lens may be indicated

10. Don’t forget :
• Quick systemic review is important and may give
you the clue for reaching the diagnosis of patient’s
ocular condition.
• Analyze patient’s complaint carefully , sometimes it
can be misleading but sometimes it can help you!!
• Dilated examination is a must to have proper
assessment of patient’s anterior and posterior
segment.