cps summary

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By: dramityadav (140 month(s) ago)

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Presentation Transcript

CPS summary : 

CPS summary

Initial symptoms : 

Initial symptoms -zig zags -migraines -dry, itchy eyes -seeing well -spks

Additional information : 

Additional information Angles found to be 2’s (at risk for angle closure) Old rx about +2 now it’s a little bit minus (about 2 diopter of + error shift) Recently began taking topomax for her migraines

Explanations : 

Explanations The migraines were present before and were considered migraines with aura the aura being the zig zag lines that she sees during the migraines improved vision can be explained by her previously being hyperopic and a myopic shift then fixing her vision (myopic shift = adding more +) The myopic shift can be explained as being a side effect of the drug topomate Topomate causes choroidal effusion the increased fluid and tissue swelling in the choroid causes an anterior rotation of the ciliary body thereby pushing the lense forward this can account for the myopic shift as well as causing the decrease in depth of the anterior chamber putting the patient at risk for angle closure (this patient allready was at risk) The angle closure she experiences accounts for the elevated pressures, halos of light, and bilateral eyepain. The iridotomy didn’t lower pressures significantly probably because it would allow aqueous to pass from posterior to anterior chambers freely but still will not allow the outflow of the aqueous through the trabecular meshwork which still remains blocked by the iris.

Gonioscopy : 

Gonioscopy At bottom no structures are visible this angle is closed Some pigment visible peeking from behind the iris possibly a slightly pigmented schwalbes line either way a very shallow angle

Ultrasound : 

Ultrasound Normal angle no fluid in choroid Black space in middle is fluid inside the choroid in the left part of the picture is the angle which is extremely narrow

Slide 7: 

At the bottom you can see fluid in what is assumed to be the choroid Top image is fluid free

Slide 8: 

Can clearly see in this image of a helthy eye the larger angle and lack of fluid in the choroid Here you can see at the small arrow a closed angle and at the fat arrow the fluid appearing black in the choroid the white outlined arrow is showing the ciliary body moved anteriorly

What’s left : 

What’s left this leaves only the spks and dry itchy eyes. This dosnt seem o go along with any of the other symptoms but spks are common and are often a stand alone problem.

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