A CASE OF SUDDEN UNILATERAL LOSS OF VISION

CASE PRESENTATION A Case of Sudden U/L loss of vision : 

CASE PRESENTATION A Case of Sudden U/L loss of vision Dr Tarun sood

Patient Particulars : 

Patient Particulars Anil Kumar Das 27 yr old Sep of 220 Med Regt Reported to Eye OPD on 27 Mar 08 Chief Complaints: Pain -06 days Sudden loss of vision RE -05 days

History : 

History No h/o trauma No h/o fever No h/o exposure to snow No h/o Drug intake of long standing duration No h/o TB/DM/HTN H/O TAKING ALCOHOL(allegedly issued from 403 Fd Amb)on22Mar–Holi(Saturday)

continued… : 

continued… Pt had mild Pain Rt Eye that day He woke up the next day with inability to see anything with his Rt eye(Sunday) He reported to 403 Fd Amb the next day (Monday) whence he was transferred to 153 GH for Ophthal opinion Reported here on 27 Mar 08

Ocular Examination : 

Ocular Examination DVA RE-HMCF LE-6/6 Both Eyes White and quiet RE – Pain and tenderness present on ocular movements( more so on looking up and medially) LE – No Pain/Tenderness

Continued… : 

Continued… RE Ant Seg:Cornea clear, AC-Normal,RAPD +nt Post Seg:Posterior Vitreous Haze +nt Disc hyperemic blurred margins peripapillary edema No Haemorrhages No Exudates Macula- Extensive Macular edema with evidence of macular fan

Continued… : 

Continued… RE COLOUR VISION Defective AMSLER CHARTING Normal LIGHT BRIGHTNESS Diminished VISUAL FIELDS(CFT) Central scotoma LE All investigations WNL

DIFFERENTIAL DIAGNOSIS : 

DIFFERENTIAL DIAGNOSIS Papilloedema Papillitis Congenital Disc Anomalies Medullated Nerve Fibres Orbital lesions Optic Disc Drusen Malignant cell infiltration of Nerve head Ocular Hypotony

Differentiating FeaturesSYMPTOMS : 

Differentiating FeaturesSYMPTOMS PAPILLOEDEMA Usually B/L Transient attacks of blurred vision No pain and tenderness PAPILLITIS Usually U/L Marked loss of vision of sudden onset Pain and tenderness with ocular movements

Differentiating FeaturesSIGNS : 

Differentiating FeaturesSIGNS Pupillary Rx,Colour visionand contrast sensitivity-Normal Media clear, Disc hyperemic, margins blurred,2to6D swelling of disc Peripapillary oedema, engorged veins,RetHges exudates,Macular star+nt Fields-Enlarged BlindSpot MarcusGunn Pupil, Colour vision defective, Contrast sensitivity decreased Media-posterior vitreous haze,Disc hyperemic,blurred margins,mild swelling Peripapillary edema,No Hges,exudates,Macular edema +nt Central /Centrocaecal scotoma

Optic Neuritis : Inflammation of optic nerve : 

Optic Neuritis : Inflammation of optic nerve Papillitis Neuroretinitis Retrobulbar Neuritis

Aetiology of Optic Neuritis : 

Aetiology of Optic Neuritis Idiopathic Demyelinating disorders Asso with infections:Local,Systemic Immune mediated disorders Metabolic disorders Toxic Optic Neuritis

Clinical Features : 

Clinical Features Loss of vision Periocular discomfort made worse on moving the eye Frontal headache Tenderness of globe Diminished Visual Acuity Marcus Gunn Pupil Colour vision defects Visual field defects Diminished light brightness sensitivity

Points in favour of papillitis : 

Points in favour of papillitis U/L Pain on eye movement Severely diminished vision RAPD Defective Colour Vision Diminished light brightness

Ophthalmoscopic Picture : 

Ophthalmoscopic Picture Posterior Vitreous Haze Disc-Hyperemic, Oedematous with blurred margins No Hges/Exudates Macular edema

Management : 

Management Investigations Hb, TLC, DLC, ESR BS-F,PP ,Lipid profile Serum Ca,K,Urea,Creatinine Urine exam ECG Chest X-ray PULSE STEROID THERAPY I/V Methyl Prednisolone 250 mg 6 hrly for 3 days foll by Oral Prednisolone 1mg/kg/day for 11 days Taper off over 3 days

Follow up : 

Follow up 31 Mar 08 – Vision improved drastically to 4/60 LE 01 April 08 – Vision improved further to 6/36 03 April 08 – Vision improved to 6/18 05 April 08 – Vision improved to 6/9p TODAY O7 APRIL VISION IS 6/6P

Conclusion : 

Conclusion Optic Neuritis is a serious condition which if not treated immediately can lead to permanent visual loss. ANY PATIENT COMPLAINING OF SUDDEN DETERIORATION OF VISION should be critically examined , thoroughly investigated and promptly managed.