Nothing Special   »   [go: up one dir, main page]
Scribd Logo
Upload

Welcome to Scribd!

  • 82 views

    CASE REPORT - Docx Formative Case - Docxxxxxxxxx

    Uploaded by

    NismaSehar
    The patient, a 73-year-old South Asian female, presented with difficulty climbing stairs, recognizing faces, and distant vision, but reading was okay with near correction. Examination found ptosis, pseudophacia with PCO in the left eye, and a macular scar in both eyes. OCT showed vitreomacular traction in the right eye and flat macula in the left. The most likely diagnoses were ARMD OU, VMT right eye, nuclear sclerosis and mature cataract right eye, and aponeurotic ptosis OU. Management included eye drops, low vision glasses, referral for ptosis surgery, nutritional supplementation, and follow up in one month.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    CASE REPORT - Docx Formative Case - Docxxxxxxxxx

    Uploaded by

    NismaSehar
    82 views8 pages
    The patient, a 73-year-old South Asian female, presented with difficulty climbing stairs, recognizing faces, and distant vision, but reading was okay with near correction. Examination found ptosis, pseudophacia with PCO in the left eye, and a macular scar in both eyes. OCT showed vitreomacular traction in the right eye and flat macula in the left. The most likely diagnoses were ARMD OU, VMT right eye, nuclear sclerosis and mature cataract right eye, and aponeurotic ptosis OU. Management included eye drops, low vision glasses, referral for ptosis surgery, nutritional supplementation, and follow up in one month.

    Original Description:

    Age related macular degenration

    Original Title

    CASE REPORT.docx Formative Case.docxxxxxxxxx

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The patient, a 73-year-old South Asian female, presented with difficulty climbing stairs, recognizing faces, and distant vision, but reading was okay with near correction. Examination found ptosis, pseudophacia with PCO in the left eye, and a macular scar in both eyes. OCT showed vitreomacular traction in the right eye and flat macula in the left. The most likely diagnoses were ARMD OU, VMT right eye, nuclear sclerosis and mature cataract right eye, and aponeurotic ptosis OU. Management included eye drops, low vision glasses, referral for ptosis surgery, nutritional supplementation, and follow up in one month.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    82 views8 pages

    CASE REPORT - Docx Formative Case - Docxxxxxxxxx

    Uploaded by

    NismaSehar
    The patient, a 73-year-old South Asian female, presented with difficulty climbing stairs, recognizing faces, and distant vision, but reading was okay with near correction. Examination found ptosis, pseudophacia with PCO in the left eye, and a macular scar in both eyes. OCT showed vitreomacular traction in the right eye and flat macula in the left. The most likely diagnoses were ARMD OU, VMT right eye, nuclear sclerosis and mature cataract right eye, and aponeurotic ptosis OU. Management included eye drops, low vision glasses, referral for ptosis surgery, nutritional supplementation, and follow up in one month.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 8

    CASE REPORT

    Loss of functional vision even

    14April 2019
    Patient Details:
    73yrs, Female, South Asian

    11/04/2019

    Presenting Symptoms:
    Referred to tertiary eye care hospital by ophthalmologist for OCT.

    Difficulty in climbing stairs

    Difficulty in recognizing faces

    Trouble in distant vision

    Reading is ok with near add

    Sensitivity to light

    Corona or shade around light, moving spots

    Dropping of both eye lid since last 6 months

    Maintain a chin up posture

    Mild discharge & redness

    General Health:
    History of contact skin allergy one month ago: 3 injections in a week, hydrocortisol cream with
    cold compression.

    HTN-nil, DM- nil no other systemic disease

    Ocular History:
    LF cataract extraction with foldable IOl implant

    Family Ocular History:


    Positive
    ADL:
    Senior citizen no specific job to do except reading Holy Book for 3hrs in a day along with
    activities of daily life.

    Clinical Signs:
    Vision – OD (sc) 2/60 OS (sc) 1/60

    Near vision – Old rx: +3.0 DS BE

    Refraction - OD: +2.00/-2.00@100 , 6/36 OS: +2.50/-2.00@60, 1/60

    Pin Hole - OD: 6/60- OS: 1/60 with ETDRS Chart.

    Near Vision - OU sc: N12 with +4.00 N8.

    AHP: Chin up

    PD: 58mm

    VD: 12.00

    Avg.Curvature – OD: 45.25 D OS: 45.50D

    RT LF

    full Eom full

    Pterygium+ Conjuctiva Pterygium+


    Senile ptosis ++, discharge lids Senile ptosis++, discharge
    NAD NAD
    Cornea
    NAD Sclera NAD

    RRR, No RAPRD Pupil RRR, No RAPD

    NS+++, cortical ++ Lens Pseudophacia, PCO

    NAD Iris NAD

    NAD AC NAD

    Tesselated flat Macula Macular scar


    0.2 CD ( +60D) 0.2

    12mmHg IOP(GAT) 11mmHg

    Image of Rt. Mature Cataract

    Differential Diagnosis:
    Myogenic Ptosis- Malfunction of the levator muscle restricts the eyelid from being elevated into
    right position. The frequent cause is myasthenia gravis, congenital myopathies, myotonic
    dystrophy, and chronic progressive external ophthalmoplegia. It`s a progressive condition
    which may recurrent. Variable ptosis is a key feature of Myasthenia Gravis. Ocular motility
    imbalance is also an association in it that in this case is normal. The other symptoms and signs
    of Myasthenia are absent (Finsterer, 2003), ( Wong , Beckingsale ,Oley and Sullivan, 2002),

    (Kasnki, 2016).
    Neurogenic ptosis: Ptosis may be caused due to the malfunction or disruptionof the central
    nervous system or to the oculomotor orsympathetic nerve(s) .As the levator has the key role in
    keeping the lid open, profound deficits of third nerve function usually results in severe or
    complete ptosis.There are no signs of Third nerve here except ptosis. Diabetes, Multiple
    Sclerosis also cause ptosis but the patient has no systemic disease history (Finsterer, 2003)

    Mechanical ptosis: Orbital fat prolapse, eyelid tumour may cause lid to be too heavy for the
    muscle to elevate it.There`s no presence of mass (Finsterer, 2003).Choroidal Revascularization
    (CNV): Sudden deterioration of vision within few days especially central vision including color
    confusion and metamorphosis (condition in which straight lines presume as wavy) Disruption of
    new blood vessels accelerate the symptoms. (“Choroidal neovascularization”, 2019).

    Cystoid Macular Edema: Retinal edema causes decrease in visual acuity along with low contrast
    sensitivity and distorted lines that cause trouble in face recognition and fine vision. Patient
    observes spot due to Scotia formation.( Nussenblatt ,Kaufman , Palestine & Davis
    ,Ferris,1987).

    Retinal Detachment: It`s more common in people above the age 50.It’s a painless condition. But almost
    every time the alarming signs pop-up before it occur or has advanced, as in the sudden onset of
    floaters, little specks which seem to loft through field of view, Flashes of light (photopsia), Hazy view,
    Progressive loss of side (peripheral) view, A curtain-like shade over field of view.

    (Kasnki, 2016).

    Most likely Diagnosis:

    ARMD: OU

    VMT: RT

    Neuclear Sclerosis – MATURE: RT

    Aponeurotic Ptosis: OU

    Investigation:
    Due to the presence scar in the left eye and flattening of macula observed through the slit lamp
    it was decided to go for the OCT scan of bilateral macula to get the clear picture of fundus
    pathology.It stated that view of both eyes were hazy with viterous macular traction in the right
    eye. Thickness of right macula was 179um and 365um of the left. Whereas, the inner retinal
    layer and retinal pigment epithelium seemed to be normal. There was an evident scaring of the
    foveal region in the both eyes with no edema and hemorrhage. Macula came out to be flat in
    the left eye ruling out ARMD in both eyes. Biomicroscopy & Central 10-degree computerized
    automated perimetry would be done in the next visit. (“Care of patient”).

    Management Of The Case In Optometry Practice (based on most likely


    diagnosis)
    Eye drops Alzox and vision1 were suggested to be instilled in both eyes four times a day for a
    month to resolve the discharge. For functional vision UVR protective (“Care of patient”) distant
    and near vision glasses were also recommended till the time patient decide to go for cataract
    extraction and IOL implantation(phaco+foldable IOL) in the right eye. Referral was made to the
    Oculoplasty department for opinion regarding ptosis as it was almost covering the visual axis of
    both eyes due to which patient maintained a chin up posture. Most probably bilateral.(
    Finsterer.J 2003).As there is no cure, but treatment could slow down the disease progression
    so to save patient from having profound visual loss. Ultimately the patient would be referred for
    low vision rehabilitation even if after phaco surgery the vision would not be equal or more the
    6/12 OU for which chances are very less due to scar formation and damage done already. Green
    leafy, other green, yellow vegetables and egg yolk were advised as that`s an enriched source of
    vitamin A, Zeaxanthin and Lutein.(“Care of patient”),(“Lutein and zeaxanthin,”
    2016),(Kasnki,2016).Food containing Omega-3,Vitamin C,E,zinc,and copper was recommended
    her to take in regular basis along with a prescription of case appropriate multivitamin dose.(“Age-
    Related Macular Degeneration”,2005),( “Care of patient”), ( Kasnki,2016).A study conducted by
    the National Eye Institute of the National Institutes of Health, namely AREDS (Age-Related Eye
    Disease Study), had proved benefits of supplement formula that has vitamins C and E, beta-
    carotene, zinc, and copper. The research stated, the risk of vision deterioration goes down for
    some patients with moderate to severe dry AMD. An updated AREDS2 formula recently
    included lutein, zeaxanthin, and omega-3 fatty acids and abolished beta-carotene, which might not
    be safe for smokers. As Beta-carotene found to cause higher risk of lung cancer in smokers. Anti-
    angiogenic drugs, Photodynamic laser therapy, Submacular surgery could be a treatment option
    that would be decided by the vitre-retinal surgeon later in the follow-ups if suitable for the
    case.(Kasnki, 2016),(“Care of patient”).Patient education was done giving information regarding
    the disease and prognosis.reviewed the symptoms also encouraged her for compliance with the
    treatment regime. Advised to promptly visit hospital if new symptoms appear i.e, blurred vision
    Scotia, dysmorphopsia) (“care of patient”), (Kasnki, 2016).Follow-up after one month had been
    scheduled.
    REFRENCES
    1. Finsterer.J 2003,` Ptosis: Causes, Presentation, and Management` Aesthetic Plastic
    Surgery` , [online],Vol.27,viewed 12 April 2019 .
    < https://link.springer.com/article/10.1007%2Fs00266-003-0127-5#citeas>.
    2. Wong V-A, Beckingsale P-S,Oley C-A, Sullivan T-M 2002,` Management of myogenic
    ptosis`American Academy of ophthalmology, [online],Vol. 109, viewed 12 Aril
    2019<https://www.aaojournal.org/article/S0161-6420(02)01009-6/fulltext>.
    3. `Choroidal neovascularization` 2019, [online], Wikipedia Available
    at https://en.wikipedia.org/wiki/Choroidal_neovascularization (Accessed:12 April 2019)
    4. Care of patient with age related macular degeneration, ‘American optometric
    association ` [online] viewed at 12 April
    2019,<https://www.aoa.org/documents/optometrists/QRG-6.pdf> .
    5. Nussenblatt R-B,Kaufman S-C, Palestine A-G, Davis M-D,Ferris F-L 1987,` Macular
    Thickening and Visual Acuity` American Academy of Ophthamology,vol.94,viewed 12
    April 2019 < http://libraryguides.vu.edu.au/harvard/journal-articles>.
    6. Lutein and zeaxanthin: Eye and vision benefits 2016, [online], All about vision, viewed
    12 April 2019, <https://www.allaboutvision.com/nutrition/lutein.htm>.
    7. Age-Related Macular Degeneration Treatment 2005, [online],WebMD,accessed on 12
    April 2019,<https://www.webmd.com/eye-health/macular-degeneration/age-related-
    macular-degeneration-treatment#1>.
    8. Mayo Clinic 2019, [online],Retinal Detachment, accessed 12 April 2019,<
    https://www.mayoclinic.org/diseases-conditions/retinal-detachment/symptoms-
    causes/syc-20351344>.
    9. Kasnki,J.(2016),Clinical Ophthalmology,8th Edition, Elsevier,598-616.
    10. Kasnki,J.(2016),Clinical Ophthalmology,8th Edition, Elsevier, 838.
    Abbreviations:
    ARMD__Age Related Macular Degeneration

    VMT___ Viterous Macular Traction

    OU: Both eyes, RT : Right eye , LF : Left eye,

    Vit.A : Vitamin A

    PD: Pupillary Distance

    VD: Vertex Distance

    AHP: Abnormal Head Posture

    SC: Without Glasses

    NAD: No Abormality Detected

    RRR : Right Round Reactive

    RAPD: Relative Afferent Pupillary Defect

    Phaco: Phacoemulsification

    PCO : Posterior Capsular Opacity

    NS: Nuclear Sclerosis

    EOM: Extra Ocular Muscles

    AC: Anterior Chamber

    IOP: Intra Ocular Pressure

    CD: Cup to Disc

    GAT: Goldmann Applanataion Tonometer

    You might also like