Year: 2022
Type: article
Study design: Case Report
Abstract: Case reportA 77-year-old female patient, under the care of an outof-hospital ophthalmology clinic because of glaucoma of approximately 15 years' duration, presented to a hospitalbased outpatient clinic to extend the diagnostic work-up following a significant progressive deterioration of vision in the right eye.A week earlier, the patient was consulted by an ophthalmologist at an out-of-hospital ophthalmology clinic.Visual acuity examination revealed V OD 0.3 and V OS 0.63 (using the patient's own spectacle correction).Intraocular pressure measured with a Goldmann applanation tonometer was T OD = 18 mmHg and T OS = 16 mmHg.Ophthalmoscopically, the optical nerve discs were found to be pale pink in color, with clearly defined borders.Until that time, the patient had used dorzolamide with timolol twice a day in both eyes.Her ophthalmic history revealed cataract surgery in the right and left eyes, and trabeculectomy in the left eye.During the patient's ophthalmic appointment several months prior to the reported one, she was referred for additional examinations, including an ultrasound of the carotid arteries, because of a decline in visual acuity in the right eye (from 0.9 to 0.5).However, the patient did not have these assessments done, nor did she come for a follow-up visit, despite the fact that her vision deteriorated further.It must be noted that the patient's previous treatment of glaucoma, spanning a dozen years or so, was uncomplicated, and the condition was well controlled for a long time despite the presence of stable defects in vision in subsequent visual field tests (Figures 1234).Considering the patient's ophthalmic history outlined above, and the decline in visual acuity, it was decided to refer her for further diagnosis and treatment at the hospital-based outpatient clinic, where further evaluations were scheduled, including a repeat visual field test.When the patient came for the additional assessments a few days later, a further decrease in visual acuity and edema of the optic nerve disc in the right eye were found.Consequently, she was urgently admitted to the hospital's ophthalmology department.Upon hospital admission, the following parameters were recorded:V OD : counting fingers before the eyes (sc) V OS : 0.63 sc // 0.9 cc +1.5 Dsph -0.5 Dcyl ax 103 T OD = 12 mmHg, T OS = 12 mmHg In view of the patient's very low visual acuity, a visual field test could not be performed.No abnormalities were revealed in the anterior segment of the eye.A fundus examination showed congestion and optic nerve disc elevation, especially in the nasal region (not present 8 days earlier during the patient's assessment at the outof-hospital ophthalmology clinic), and vascular tortuosity in the right eye.In the left eye, the examination revealed pallor of the disc with slight blurring of its inferior margin (Figures 5, 6).During the medical appointment, in addition to a significant decrease in visual acuity, the physician's attention was drawn to the patient's behavior, which was perceived as in-ABSTRACT A 77-year-old female patient who had been treated for glaucoma for many years was referred to an outpatient clinic to extend the diagnostic work-up because of rapidly deteriorating vision despite anti-glaucoma treatment.During the visit, in addition to characteristic ophthalmic symptoms, behavioral and orientation disturbances were found, which raised a suspicion of Foster Kennedy syndrome and prompted the examining physician to refer the patient for an urgent brain scan.A computed tomography examination revealed the presence of focal lesions.Rapid diagnosis enabled immediate transfer of the patient to a neurosurgical center for further treatment.
Source: Klinika Oczna
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4313045005