Eye Health Case Studies

1. Optic Atrophy/ Optic disc drusen:
History/Findings: Patient: 35 year old female
Symptoms: - severe headache
- lost a lot of vision
- searching vision
- counting fingers
- unable to read Assessment:
- Extensive optic atropy - severe damage to patient's optic nerves. Patient registered with CNIB

Visual field # 20043

2. Ocular hyptension/ Glaucoma
Post Retinal detachment repair

Post vitrectomy

History/Findings
Patient: 84 year old male
Symptoms:
- intermittent blurry vision
Vision:
- no vision in right eye
- left eye shows: - high intraocular pressure (31 mm Hg)

- macular fibrosis
- post retinal detachment repair
- post vitrectomy
- pseudophakia (posterior chamber lens)
(cataract removed)

Assessment:
- Retina flat and stable
- Timoptic for pressure, to be reassessed in one month

Visual field # 21211

Fundus #21211 & #21211R

3.Choroidal Tear Through Macula:
History/Findings:
Patient: 38 year old female
August 1994 - Blunt injury with a tennis ball in the left eye - leading to a devastating
choroidal tear through the macula and loss of vision to a "poor counting fingers"
Assessment:
- Scarring of macula, with full peripheral vision in left eye but no central vision.

Fundus #3145-2

Visual field #3145-2

4.Choroidal neovascular membrane - right eye:
History/Findings:
Patient: 61 year old male
- right focal laser 1991 for choroidal neovascular membrane
- vision in right eye 20/20
Assessment:
- Patient to use Amsler grid daily to assess central vision and report any change.

Fundus #19745R

Visual field #19745

5.Right incomplete central retinal vein occlusion:
History/Findings: Symptoms:
- Patient awoke realized the right eye had become a bit blurry in the centre.
Vision:
- Showed 20/30 in the right eye, 20/20 in the left.
- Right eye showed on retina incomplete retinal vein occlusion, with extreme tortuosity
especially of inferior veins, cotton wool spots with blurriness of the disc margin.
Assessment:
- Patient to take entrophen 325mg orally.
- Patient investigated for: CBC, Sed Rate, Glucose, FTA antibodies, Rheumatoid \
Factor, VDRL, Uric Acid, Protein Electrophoresis, Liver and Kidney Panel, Thyroid
scan and CT scan.
1 year later:
- Laser treatment required, resolving visual acuity in right eye 20/25 -2 ; then macular
edema, vision reduced to 20/50, in the right eye.

Fundus #7262-1R

6. Chronic Resolved papilledema - right eye
History/Findings:
Symptoms:
- Bilateral Chronic papilledema
- Right optic nerve decompression
- Previous pseudotumor cerebri with shunt
- Unaided visual acuity: right eye - 20/20
Left eye - 20/20-
- Intraocular pressure: 10 mm Hg in each eye
Assessment:
- Patient advised to have stereo-disc photography and 32-2 visual fields, annual eye
exams, and report any visual change.

Fundus #21569-1R

Visual field #21569-1

7. Dominant Drusen
History/Findings:
Patient: 58 year old female
Visual acuities: unaided 20/20 in each eye
No obvious visual problem
Assessment:
- Annual eye exams, with visual fields
- Patient advised to do an Amsler grid, daily.

Fundus #1168-1R & #1168-1

8. Venous branch occlusion:
History/Findings:
Patient: 49 year old male
Symptoms:
- No subjective complaints and a recent general checkup with family doctor indicates he is in good health.
Assessment:
- Amsler grid shows a slight distortion down into his right with a venous branch occlusion to the right optic disc where the arteriole opposes the right superior temporal vein.
- Patient advised to have his blood pressure reviewed, and the viscosity of his blood. Fluorescein angiography ordered.

Fundus #1751-1R

9. a) Keratoconus/with corneal transplant on left eye 20 years ago
b) Bilateral papilloedema extending beyond discs into papillomaculararea.
c) Intracranial Hypertension
History:
Patient: 41 year old male
Symptoms:
- Sudden visual observations as if seeing "white" clouds
- Left eye had keratoconus and patient underwent a corneal transplant 20 years ago.
Findings:
- Findoscopy - established papilledema on both sides
- Foveas flat
- Left eye showed a successful penetrating keratoplasty with faint interstrial changes virtually through the graft itself.
- Patient blood pressure 230/135
- CT scan: negative
- Patient referred to a neurologist and refused to show up for any further testing.

Fundus #19009R & 19909

Visual field #19909

Corneal topo. #19909

10. Ocular Histoplasmosis Syndrome:
History:
Patient: 51 year old female
Findings:
- Progressive decrease in vision in the left eye over past months.
- Current vision with spectacles: Right eye: 20/400 ........................................................Left eye: 20/30
- Disciform macular scar- right eye
Recommendations:
- Do Amsler grid
- Annual eye examination

Fundus #15188-1R & #15188-1

11. Bilateral Papilledema:
History:
Patient: 32 year old male.
Symptoms:
- Patient noticed a little blurriness in his eyes, other wise asymptomatic.
Visual acuities: Right eye 20/30 ...........................Left eye 20/30
Visual fields: Left inferior homonymous quadrantanopia
Intraocular pressures: 17 to 18
Opthalmoscopy: Full quadrant evaluation showing bilateral papilledema.
Radiology: CT scan - temporal lesion (malignant) catching the patient's optic radiation.
Resolution: 7cm tumor removed, patient is back at work and vision has returned.

Fundus #13922R & #13922

Visual field (central 30-2 threshold) #13922

12. Keratoconus - Bilateral:
History:
Patient: 55 year old female
Visual acuities with spectacles: Right eye : -4.59 -3.75 x 158 20/80 .......................................................Left eye: -5.25 -4.75 x 022 20/400
Corneal topography: Marked irregular astigmatism
Visual Plan:
- Low vision clinic
- Contact lenses no longer comfortable
- Left penetrating keratoplasty
- Annual review with no treatment

Corneal top. #6156-2

13. Choroidal Rupture:
History:
Patient:45 year old female
Symptoms:
- orbital fracture due to a car accident
- double vision
Visual acuities: Right eye: 20/20
Left eye: 20/30
Assessment:
- annual eye examination with visual field and fundus photos

Fundus # 4550-2R & #4550-2

The information provided in this article and elsewhere on this website are for informational purposes only, and should NOT be considered a medical diagnosis or advice. When in doubt, please visit your local optometrist for a complete professional evaluation.