Topic

#Case Discussion

19 articles
  1. Students Gallery 27 May 2021 12 min read

    i-File: COVID-19 associated Mucormycosis

    A 53-year-old female presented to the emergency with chief complaints of drooping of the left eyelid for 3 days and sudden loss of vision in the left eye for 2 days. History of Present Illness: The patient was recovering from COVID-19 infection prior to presentation when she noticed a sudden, rapidly progressive drooping of the left eyelid over 3 days duration. It was associated with the limitation of extraocular movements. Loss of vision was sudden, associated with pain, and fullness around the eye. She had a history of the left-sided nasal block along with altered sensation over the left cheek for 1 day. She had no history of fever, toothache, trauma, hospitalization, or intake of steroids. Past Ocular History: Underwent cataract surgery in both eyes 2 years back. Past Medical History/ History of Medication: She tested COVID positive 2 weeks prior to the current presentation and was advised home quarantined. CT chest score was 3, and spO2 was maintained throughout the quarantine peri

    Dr. Nisar Sonam Poonam, M.S.(ophthal), F.M.R.F (Orbit & Oculoplasty)
  2. Students Gallery 14 May 2021 12 min read

    i-File: Vogt-Koyanagi - Harada disease

    Brief Scenario of the case: A 25 year-old-female, resident of Rajasthan presented to us with the chief complaints of diminution of vision in the right eye for a period of 3 days and redness with mild pain in both eyes for one month. History of Present Illness: The patient was apparently well 3 days back when she started to develop diminution of vision in her right eye. She had mild pain and redness in both her eyes for the last one month. Past Ocular History: She was diagnosed as a case of right eye choroiditis elsewhere. Routine blood counts were normal. Erythrocyte sedimentation rate (ESR) was 22mm in the first hour. Veneral Disease Research Laboratory (VDRL) test was negative. Human Immunodeficiency Virus (HIV) test was negative. Past Medical History/ History of Medication: The patient was using topical steroids and cycloplegic eye drops. No history of tuberculosis or any systemic disease. Family History: There was no significant family history. Review of Systems/Systemic Examinatio

    Dr. Navneet Mehrotra · Dr. Nivesh Gupta
  3. Articles 15 Apr 2021 15 min read

    i-File: Exfoliation Glaucoma

    A 65-year-old male presented to the OPD with complaints of painless, gradually progressive dimunision of vision of the right eye over several months. History of Present Illness: The Patient was apparently normal 1 year ago since when he noticed dimunision of vision of the right eye by closing the left eye by chance. The vision progressively got worse. No h/o pain, watering, halos, glare or double vision. Past Ocular History: No H/o trauma or ocular surgery. Past Medical History/ History of Medication: No systemic illnesses. No H/O taking any steroids or long term medications Family History: Not significant. No family history of glaucoma. Review of Systems/Systemic Examination: Normal. Vitals were normal. OCULAR EXAMINATION Best Corrected Visual Acuity (Snellen) Right eye (OD): 6/60 Left eye (OS): 6/9 Ocular Motility/Alignment: Full, free, and painless in all gazes. Intraocular Pressure (IOP) OD: 55mmHg (@ 2pm using Goldmann Applanation Tonometry) OS: 19mmHg (@ 2pm using Goldmann Applan

    Dr. Sahebaan Sethi
  4. Students Gallery 14 Apr 2021 3 min read

    i-File: Stargardts Disease

    Question A 35-year-old otherwise healthy female ( computer professional) presented with OU diminution noticed recently. BCVA OD 6/12 N6 and OS 6/18 N8. Anterior segment including IOP were normal in both eyes. Fundus examination revealed as depicted in the color fundus photo. What is the diagnosis( a differential is preferred) How do you manage this case Answer: The diagnosis is Stargardt’s Disease(SD)/Fundus flavimaculatus (FFM) Few Features: The onset of SD is generally in the first or second decade of life whereas FFM generally manifests after the 3 decades. The main presenting symptoms generally decrease in central vision. VISUAL ACUITY DOES NOT CORRELATE WITH FUNDUS APPEARANCE. Dyschromatopsia, nyctalopia, and visual field loss are generally not present. The earliest clinical sign is the loss of the foveolar reflex with symmetrical RPE alterations. Atrophy of fovea is generally marked by granularity, mottling, and presence of FLECKS(irregular-shaped yellow-white lesions with shapes

    Dr. Bikramjit Pal
  5. Students Gallery 12 Apr 2021 6 min read

    i-File: Valsalva Retinopathy

    Brief Scenario of The Case: A 50-year-old male patient was seen on 27th January 2021 with a chief complain of sudden painful loss of vision in his right eye for 1 week after lifting a heavyweight object at work. History of Present Illness: The patient’s only complain was a black spot and decreased vision in an otherwise normal right eye, which occurred after lifting a heavyweight object (100 kg) at work. Past Ocular History: The patient was using glasses for near vision (+1.00DS) for both eyes. Past Medical History: The patient was a chronic tobacco chewer. He had no other significant medical history. Family History: No family history of hypertension, diabetes, any neurological disease, or coagulopathy condition. Systemic Examination: The patient had a blood pressure of 120/80, RBS was 127 mg%, his Pulse rate was 78/min. His central nervous system, circulatory system, and respiratory system examinations were normal. Ocular Examination: 1. Best-corrected visual acuity (Snellen) • Right

    Dr. Maradula Gangawar · Dr. Dhaivat Shah
  6. Students Gallery 12 Apr 2021 12 min read

    i-File: Fuchs Endothelial Dystrophy

    A 55-year-old female presented to the Cornea clinic with gradually progressive diminution of vision in both eyes for 1 year, which was associated with intermittent photophobia and colored haloes around lights, especially on waking up in the morning. The blurry vision gradually became clearer as the day progressed. No history of associated pain, watering, redness, itching, or discharge. Past Ocular History: No history of ocular trauma or surgery in the past Past Medical History/ History of Medication: No significant systemic history could be elicited. Patient was not on any medication. No addictions. Family History: No significant family history found Review of Systems/Systemic Examination Systemic examination was within normal limits. All vitals were within normal limits. OCULAR EXAMINATION Best Corrected Visual Acuity (Snellen) Right eye (OD): 6/36 Left eye (OS): 6/12 Ocular Motility/Alignment Full, free, and painless in all gazes Intraocular Pressure (IOP) OD: 16 mm of Hg OS: 16 mm o

    Dr. Hema Joshi, MBBS, DO, DNB
  7. Students Gallery 12 Apr 2021 3 min read

    i-File: Idiopathic Juxtafoveal Retinal Telangiectasia

    Question A 61-year-old presented with OU diminution of vision. He complains of distortion of letters which he has noticed in the last few months. He is a well-controlled diabetic for 13 years. There are no other systemic issues. Examination revealed a BCVA of OD 6/18(P) N8, OS 6/24 N8. The anterior segment is unremarkable except for pseudophakia OU (no e/o PCO). Fundus and FFA as shown What is the most probable diagnosis (give your differential)? Which other investigation will help in the diagnosis How will you treat the patient? Answer: Idiopathic Juxtafoveal Retinal Telangiectasia(IJRT) Classification COATS Subretinal exudation without vascular abnormalities Subretinal exudation with vascular abnormalities Exudation with AV malformation This classification is mostly for interest and not followed anymore GASS and BLODI ( 1993) This classification was a modification of the original Gass and Oyakawa classification of 1982 1A) Congenital in nature, having a UNILATERAL presentation in MAL

    Dr. Bikramjit Pal
  8. Students Gallery 12 Apr 2021 5 min read

    i-File: Retinal arterial macroaneurysm (RAM)

    Question A 52-year-old female presented with sudden onset blurring of vision in OD for 2 weeks. She is a known case of hypothyroidism on regular treatment. There is no other systemic illness. The best-corrected visual acuity in OD was 6/36(p) N12 and 6/6 N6 in OS. The anterior segment is unremarkable. The fundus is as shown: What is the most probable diagnosis? How will you manage the case (investigations and treatment both) Answer: RAM is generally acquired retinal aneurysmal dilation typically occurring within the first 3 bifurcations of the central retinal artery most commonly seen in elderly hypertensive females. 1. Clinical Classification a) Hemorrhagic Hemorrhage is the major component extending more than 1 DD with visual loss b) Exudative Exudation is the major component responsible for visual loss c) Quiescent Either there is no hemorrhage or exudation or there exists minimal hemorrhage and exudation with minimal or no visual loss They can be further subdivided as predominantly

    Dr. Bikramjit Pal
  9. Students Gallery 12 Apr 2021 6 min read

    i-File: Vitreous Haemorrhage

    Question A healthy 26-year-male presented with sudden onset diminution of vision in OS of 1-week duration. The loss of vision was not associated with any trauma, pain, redness. No history of flashes. No previous history of a similar episode. On examination BCVA OD: 6/9 N6; OS: HM. Anterior segment unremarkable OU. Fundus: OD: as depicted in the fundus and FFA, OS: had a dense vitreous hemorrhage What are the differentials for the case based on the fundus picture/ Fundus Fluorescein Angiogram? How do you manage it? Answer: Let’s go in a stepwise fashion to decipher this question. The relevant points from history and FFA are The patient is young with no previous such episodes The loss of visual acuity is 1 week Although not mentioned, we presume the patient to be non-diabetic, and is not hypertensive; however, the same needs to be investigated The better eye has a large frond of NVE( neovascularization elsewhere) in the temporal quadrant So differentials in a young with dense vitreous he

    Dr. Bikramjit Pal

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