History of Present Illness
A 41-year-old woman with a past ocular history significant of redness and “inflammation” of both eyes (OU) treated by an optometrist in town presents for the first time to the clinic complaining of blurred vision and severe headaches for the last 6 weeks. The headaches are more intense lately, and the last 2 days she has associated emesis and photophobia.
She also has a history of high myopia and wears soft contact lenses. Her optometrist started her on corticosteroid eye drops for the redness and discomfort about 1 year ago. The prescription of corticosteroid eye drops was refilled continuously by her primary care physician. Her last eye examination was 1 year before her current presentation .
Exam
| OD | OS | |
|---|---|---|
| Visual acuity | Count fingers (CF) 4′ | 20/30 |
| Intraocular pressure (IOP) | 47 | 40 |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Clear | Clear |
| Anterior chamber (AC) | Deep and quiet | Deep and quiet |
| Iris | Normal, no transillumination defects (TID) | Normal, no TID |
| Lens | + PSC cataract | + PSC cataract |
| Anterior vitreous | Clear | Clear |
(A) Color fundus photograph of the right eye shows an optic nerve with complete loss of the neuroretinal rim with peripapillary atrophy; a macular scar; lattice degeneration; and scattered inactive, punched-out chorioretinal scars in the periphery. (B) Color fundus photograph of the left eye shows an optic nerve with advanced loss of the neuroretinal rim, with peripapillary atrophy; normal macula; lattice degeneration; and scattered inactive, punched-out spots of the periphery.
(A) 10-2 Humphrey visual field test of the right eye shows a near-complete loss of peripheral vision with a central scotoma. (B) 10-2 Humphrey visual field test of the left eye shows a severe loss of peripheral vision with a dense superior and inferior arcuate defect.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
