The document presents a case of a 30-year-old female diagnosed with exudative retinal detachment (ERD) associated with severe pre-eclampsia, showing acute onset of blurred vision and curtain-like visual disturbances following emergency cesarean delivery. ERD, although rare in pre-eclampsia cases, is linked to choroidal ischemia and can lead to significant visual impairment if untreated; however, with proper management focusing on blood pressure control and timely delivery, the visual prognosis can be favorable. The case emphasizes the importance of multidisciplinary care between obstetricians and ophthalmologists for optimal maternal and fetal outcomes.

1. CASE PRESENTATION
Dr. Rahul Gupta
2nd year Resident
Department of ophthalmology
8th January, 2025

2. • H. No: 81049059
• Name: Samjhana Tamang
• Age : 30 years
• Sex : Female
• Occupation : Housewife
• Address : Melamchi-7, Sindhupalchowk
• Contact: 9703932191
• Mode of presentation: Gynaecological ER
• Date of Presentation : 2024/12/26

3. CHIEF COMPLAINS
1. Sudden blurring vision of both eyes since 1 day
2.Curtains lines floating across vision of both eyes since 1 day.

4. HISTORY OF PRESENTING ILLNESS
• Patient was apparently well 1 day back when she presented to Gynaecology
Emergency with complain of uterine bleeding and lower back pain and diagnosed as
P2G2L1 34 WOG with Severe Pre-eclampsia. On 1st day of admission she went
emergency LSCS after which she complained sudden blurring of vision in both eyes.
• It was acute in onset, non-progressive, painless, associated with curtain like falling
lines floating across vision.
• There was no complain of color haloes, flashes of light, floaters of glare.
• There was no complain of pain, redness, watering or photophobia.
• There was no complain of headache, trauma.

5. HISTORY OF OCULAR ILLNESS:
• No similar ocular illness in the past.
• No any ocular surgery in past.
• No history of use of glasses.
HISTORY SYSTEMIC ILLNESS:
• No any chronic illness lke Hypertension, Diabetes,
• No any surgical history.

6. TREATMENT HISTORY
• No any treatment or medication history known in past,
• Patient was treated with following medications during her hospital stay;
1. Injection Labetalol 100mg IV
2. Injection Magnesium Sulphate 4gm IV + 5 gm IM
then 5 gm IM 6 hourly
3. Inj. Ceftriaxone 2 gm IV BD
4. Inj. Ranitidine 50mg IV BD
5. Inj. Pethidine 50mg IM TDS
6. Inj. Phenargan 25mg IM TDS
7. Inj. Paracetamol 1gm IV TDS
8. Inj. Tranexamic Acid 1gm IV TDS

7. PERSONAL HISTORY
– Non Vegetarian,
– Non - Alcoholic
– Non- Smoker
– Regular bowel and bladder habit
– Good appetite
FAMILY HISTORY
-No similar history in the family
SOCIO-ECONOMIC HISTORY
-Patient comes under average middle class

8. DRUG AND ALLERGY HISTORY:
• No any known allergies to drugs or food.

9. EXAMINATION

10. GENERAL EXAMINATION
Physical examination
• Ill looking, concious and oriented to time, place and person
• Average built, anxious
Vitals
Temp : Afebrile
Pulse : 84/min
Respiratory rate : 22/min
Blood pressure : 160/90mm of Hg at right arm
Pallor/Icterus/Lymphadenopathy/Clubbing/Edema/
Cyanosis/dehydration : Absent

11. SYSTEMIC EXAMINATION
Respiratory system – B/L vesicular breath sound
Cardiovascular system - S1 & S2 audible; no murmur
Nervous system: sensory and motor system intact
Gastrointestinal system: Normal bowel sound, No
organomegaly

12. Ocular Examination
1. Visual acuity (VA) at bed side
2. Near vision: - Could’nt be performed at
bedside
2. Refraction
- Could’nt be performed
at bedside
Right eye Feature Left eye
Counting
Fingers at 3
meter
VA( unaided)
At bed side
Counting
Fingers at 3
meter

13. External Ocular Examination
HEAD POSTURE NO HEAD TILT, CHIN LIFT, OR FACE
TURN,
FACIAL SYMETRY BILATERAL SYMMETRICAL
Orbit Normal

14. RIGHT EYE LEFT EYE
FULL RANGE IN ALL THE
DIRECTION OF GAZE
EOM FULL RANGE IN ALL THE
DIRECTION OF GAZE
EOM- Full in all range

15. RIGHT EYE LEFT EYE
HIRSCHBERG TEST Reflex present at center Reflex present at center
COVER TEST NO ANY CORRECTIVE
MOVEMENT
NO ANY CORRECTIVE
MOVEMENT
UNCOVER TEST NO ANY CORRECTIVE
MOVEMENT
NO ANY CORRECTIVE
MOVEMENT
ALTRANATE COVER TEST NO ANY CORRECTIVE
MOVEMENT
NO ANY CORRECTIVE
MOVEMENT
Impression: Orthophoria

16. OCULAR EXAMINATION
EYEBROWS RIGHT EYE LEFT EYE
SYMMETRY Symetrically placed,
Comma- shaped.
Symetrically placed,
comma shaped.
CILIA Evenly distributed brow
hairs
Evenly distributed brow
hairs
PAF
HORIZONTAL 28mm 29mm
VERTICAL 10mm 10mm
LID CREASE HEIGHT 3mm 3mm

17. RIGHT EYE EYELIDS LEFT EYE
• UPPER LID-COVERS 2 MM OF
CORNEA
• LOWER LID- TOUCHES THE
LIMBUS
POSITION • UPPER LID-COVERS 2 MM OF
CORNEA
• LOWER LID- TOUCHES THE
LIMBUS
Lateral Canthi is Acute, and medial
canthus is rounded.
CANTHI Lateral Canthi is Acute, and medial
canthus is rounded.
margin flat, horizontal fold of skin
of lower lid present. no inward or
outward rolling. No swellings, no
pus point
LID MARGIN margin flat, horizontal fold of skin
of lower lid present. No inward or
outward rolling. No swellings, No
pus point
No drooping of eye lid, No loose
eyelid skin
No drooping of eye lid, No loose
eyelid skin
4 rows upper lid
around 2 rows in lower lid.
Misdirected lashes present with
eyelashes deviated inwards
toward the eye.
• No extra rows of lashes
• No loss of lashes
• No graying of lashes
EYE LASHES 4 rows upper lid
around 2 rows in lower lid.
Misdirected lashes present with
eyelashes deviated inwards
toward the eye.
• No extra rows of lashes
• No loss of lashes
• No graying of lashes
OD
OS

18. RIGHT EYE LEFT EYE
• Skin fold originating at upper
eyelid crease and merges into the
skin near the medial canthus.
• SWELLING,TENTDERNESS (-)
• NORMAL
• 6mm FROM INNER CANTHUS
• 6.5mm FROM INNER CNATHUS
• NO SWELLING, ERYTHEMA
INDURATION,PUS POINTS or
TENDERNESS
EPICANTHAL FOLD
LACRIMAL
APPARATUS
LACRIMAL GLAND
LACRIMAL PUNCTA
UPPER
LOWER
LACRIMAL SAC AREA
• Skin fold originating at upper eyelid
crease and merges into the skin near
the medial canthus.
• SWELLING,TENTDERNESS (-)
• NORMAL
• 6mm FROM INNER CANTHUS
• 6.5mm FROM INNER CANTHUS
• NO SWELLING, ERYTHEMA
INDURATION,PUS POINTS or
TENDERNESS

19. RIGHT EYE CONJUNCTIVA LEFT EYE
• Semi transparent with network of
vessels distinctly visible
• No
congestion/chemosis/discoloration
• No papillae/ discharge
• No follicles/ concretions/ congestion
BULBAR
UPPER TARSAL
LOWER TARSAL
AND FORNIX
• Semi transparent with network of
vessels distinctly visible
• No congestion/chemosis/discoloration
• No papillae/ discharge
• No follicles/ concretions/ congestion/

20. RIGHT EYE LEFT EYE
No dilated
episclersal vessels
SCLERA No dilated
episclersal vessels
SIZE: Horizontal -11.5mm, vertical- 11mm.
SHAPE : uniform curve.
SURFACE: Uniformly Smooth and regular
TRANSPARENCY: Clear with no scar
• No bulging, opacity, ulceration, dystrophy,
degenration, vascularization or deposits noted.
CORNEA SIZE: Horizontal -11.5mm, vertical- 11mm.
SHAPE : uniform curve.
SURFACE: Uniformly Smooth and regular
TRANSPARENCY: Clear with no scar
• No bulging, opacity, ulceration, dystrophy,
degenration, vascularization or deposits noted.
QUIET, NORMAL DEPTH(Van Herick grade IV) ANTERIOR
CHAMBER
QUIET, NORMAL DEPTH(Van Herick grade IV)
• Brown In color with normal pattern distribution
of crypts and collarette.
• No pigments, nodules, atrophy, adhesions,
vascularization, tremulousness noted.
IRIS • Brown In color with normal distribution of crypts
and collarette

21. RIGHT EYE LEFT EYE
ROUND REGULAR
REACTIVE(Brisk)
PUPIL ROUND REGULAR
REACTIVE(brisk)
SINGLE NUMBER SINGLE
• Normal
• Absent
Light Reflex
RAPD
• Normal
• Absent
• Normal position, No
subluxation or dislocation.
LENS • Normal position, No
subluxation or dislocation.
• Soft
• 9mmHg
• Digital Palpation
• Applanation Tonometry
• Soft
• 9mmHg

22. RIGHT EYE POSTERIOR SEGEMENT LEFT EYE
• Normal Transparent
vitreous
• No floating strands, cells,
blood or membrane
visualized.
VITREOUS • Normal Transparent
vitreous
• No floating strands, cells,
blood or membrane
visualized.

23. Fundus Examination

24. DIFFERENTIAL DIAGNOSIS
• Serous Retinal Detachment
• Regmatogenous Retinal Detachment
• Tractional Retinal Detachment
• Central Serous Chorioretinopathy
• Vitreous Hemorrhage
• Central Retinal Artery Occlusion
• Optic Neuritis

25. Reports From Previous Investigation
1. Complete blood count: Within Normal limit
2. Blood group: “B Positive”
3. Hemoglobin: 9.9 g/dl
4. Serology: Non Reactive
5. Total Protein : 5.6 low (6.5-8.2)
6. Serum Albumin : 2.6 low (3.5-5)
7. Creatinine : 1.6 High(0.4-1.1)
8. Uric Acid : 8.8 High(2.4-5.7)
9. Liver Function Test : Within Normal Limit
10. Renal Function Test : Within normal Limit
Urine RME: Within normal Limit

26. • INDIRECT OPHTHALMOSCOPY: ALTERED RED AND
GREYISH - WHITE REFLEX IN PUPILLARY AREA
FUNDUS EVALUATION:
• Vitreous was Transparent
• Both fundus shows balloning with fluid collection within
retina temporal to macula
• Convex elevation of retinal layer with presence of
vascular network.
• No traction band noted, no retinal foldings or tears noted.

27. Treatment:
1. Gtt. Acular LS 1 Drop BE TDS for 1 month.
2. control High Blood pressure
Patient Councelling done.
Follow up Advised In OPD.

28. Case Reviewed in OPD on 31st Dec, 2024
Chief Complain:
• Mild improved vision of both eyes

29. Ocular Examination
1. Visual acuity (VA) 2. Refraction
No improvement
(retinoscopy)
Right eye Feature Left eye
6/18
VA( unaided) 6/18
6/18 VA (with
pinhole)
6/18 0
0

30. 3.Slitlamb Examination:
Eyelid : Epicanthus Tarsalis noted.
Eyelashes : Trichaisis Present = Epilation done under topical Anaesthesia.
Cornea: Superficial Puntate Keratitis noted at lower region.
Pupil : RRR, RAPD absent, Altered red and greyish glow noted.

31. • fundus evaluation Under mydriatics

32. No defect to finger confrontation
4.IOP assessment via
goldman applation
9mm Hg 9mm Hg
@10:45 AM
5. Confrontation Test
LE RE
T N
N T

33. 6. Color Vision : Normal
7. Contrast Sensitivity : BE-1.68 logunit

34. 8. B- SCAN

35. 9. OCT Scan

36. Provisional Diagnosis
• BE Trichiasis with Epicanthus Tarsalis with Serous Retinal
Detachment Resolving (Temporal Region) with Grade 1
Hypertensive Retinopathy with Resolving seroius Pre-
eclampsia.

37. Treatment
• Gtt. Acular LS(Ketorolac) 1drop BE TDS for 1 month
• Other Medication continued as per Cardex
• Protective Glass advised
• Strict control of High Blood pressure advised
Note: Patient councelling done regarding visual prognosis
Follow up : 1 week / SOS

38. Case
Report

39. Summary of case reports:
• Exudative retinal detachment (ERD) is an uncommon but significant ocular complication associated
with preeclampsia, a hypertensive disorder occurring during pregnancy. ERD involves the accumulation
of fluid in the subretinal space, leading to the separation of the neurosensory retina from the retinal
pigment epithelium, which can result in visual disturbances and potential vision loss if not promptly
addressed.
• The pathophysiology of ERD in preeclampsia is thought to involve choroidal ischemia due to increased
choroidal blood flow impedance, resulting from severe hypertension during pregnancy. This disruption
may lead to fluid leakage and subsequent retinal detachment.
• Although visual symptoms are reported in 25-50% of preeclamptic patients, ERD remains a rare
manifestation, occurring in less than 1% of preeclampsia cases and about 10% of eclampsia cases.
Common visual symptoms include blurred vision, scotoma, and decreased visual acuity. Fundoscopic
examination typically reveals multiple areas of retinal detachment without signs of hypertensive
retinopathy.
• Management of ERD in preeclampsia primarily focuses on controlling blood pressure and timely
delivery of the fetus. Visual prognosis is generally favorable, with spontaneous resorption of subretinal
fluid and complete resolution of the detachment occurring within a few weeks postpartum.
• In summary, while ERD is a rare complication of preeclampsia, it necessitates prompt recognition and
management to prevent potential vision loss. Multidisciplinary care involving obstetricians and
ophthalmologists is crucial to ensure optimal outcomes for both mother and child