CASE PRESENTATION
PRESENTER: DR.A.B.M.MAHFUZUR RAHMAN
DO RESIDENT , GOPALGONJ EYE HOSPITAL & TRAINING INST
PARTICULARS OF THE PATIENT
• Name: Mrs. Shohida Begum
• Age: 45 years
• Sex: Female
• Occupation: Housewife
• Marital status: Married
• Address: kalkini,Madaripur
• Date of admission : 15.03.2025 at 2.30 P.M
• Date of examination : 16.03.25 at 9.00A.M
CHIEF COMPLAINTS
• Sudden dimness of vision in left eye for 7 days.
HISTORY OF PRESENT ILLNESS
• According to the patient statement she was reasonably well 7 days
back. Then she developed sudden painless dimness of vision in left
eye which was not associated with redness, lacrimation, photophobia.
There was no history of trauma, flashing of light, ,fever, spontaneous
bleeding,jonit pain.Her visual condition markedly detoriate on waking in
the morning. She is suffering from hypertension & diabetic malitus for 5
years and takes antihypertensive, antidiabetic medication for same
duration. With above complaints she came to this hospital for better
management.
PAST OCULAR HISTORY
• No history of ocular trauma.
• No history of ocular surgery.
PAST MEDICAL HISTORY
• No significant past medical history.
DRUG HISTORY
• She takes oral antidiabetic & anti hypertensive drugs but could not
mentioned.
• She has history of taking oral contraceptive pills.
ALLERGIC HISTORY
• No history of food and drug allergy.
PERSONAL HISTORY
. She is non smoker but betel nut chewer for several years.
FAMILY HISTORY
• No significant family history.
SOCIO-ECONOMIC HISTORY
• She belongs to a low socio-economic status.
GENERAL PHYSICAL EXAMINATION
• Appearance : ill_ looking
• Cooperation : cooperative
• Body built: Average
• Anemia : Absent
• Jaundice: absent
• Cyanosis: absent
• Oedema : absent
CONTI……
• Lymph node: not palpable
• Thyroid gland : NAD
• Neck vein: not engorged
• Pulse: 80b/min
• Blood pressure: 130/80 mmHg
• Temperature : 98°F
OCULAR EXAMINATION
Points Right eye Left eye
Visual acuity Distance vison Distance vison
Unaided : 6/6 Unaided: CF3”
Pinhole: With Pinhole :not
Aided: improved
Near vison: N12 Aided: Not improved
Near vison: can’t see
PLR
Brisk
RAPD: Absent Sluggish
RAPD: Present
Colour vison Trichromatic Desaturated
Field of vison Normal Restricted (Both
periphery and central)
Hirschberg reflex Central Central
Ocular motility Full in all gaze Full in all gaze
SLIT LAMP BIOMICROSCOPE EXAMINATION
Points Right eye Left eye
Eyelid & eye lash Normal Normal
Conjunctiva Not congested Not congested
Cornea Transparent Transparent
Anterior chamber Normal in depth & clear Normal in depth & clear
content content
Iris Normal in color & pattern Normal in color & pattern
Pupil Round, regular, reacting Round, regular, reacting
to light to light
Lens Transparent Transparent
IOP 10 mmhg 14 mmhg
FUNDOSCOPIC EXAMINATION
Points Right eye Left eye
Media Clear Clear
Disc Size – normal Hyperaemic,indistinct
Shape- round margin,obliteration of
Color- pink physiological cup
Margin- well defined
C:D ratio 0.3: 1 Obliteration of
physiological cup
Macula Healthy Foveal reflex dull
Peripheral retina Normal Extensive flame shaped,
dot blot hemorrhage,
cotton wool spot present
in all four quadrant. All
branches of retinal vein is
dilated & tortuous.
SYSTEMIC EXAMINATION
Nervous system:
• Higher psychic function : intact
• Cranial nerves: normal functioning
• Motor function: good
• Sensory function: intact
• Cardiovascular system:
• Pulse : 80b/min
• Blood pressure: 130/80 mmhg
• Heart sound: normal
CONTI…….
• Respiratory system:
• Respiratory rate : 18b/min
• Palpation : NAD
• Percussion : Resonance
• Auscultation: Normal
• Renal system : NAD
SALIENT FEATURE
• Mrs. Shohida Begum 45years old, diabetic, hypertensive patient hailing
from kalkini, Madaripur with the complaints of sudden dimness of vision
in her left eye for 07 days. She takes antihypertensive & anti diabetic
drugs regularly.
• She has no history of redness, photophobia, lacrimation, any ocular
surgery ,trauma, color halos,fever, flashing of light,spontaneous
bleeding, joint pain.
CONTI……
• On systemic examination her blood pressure is 130/80mmhg, pulse 80b/min.
• On ocular examination her visual acuity was 6/6 in right eye and CF 3” in left eye
which was not improved with pin hole & refraction. She could not see the near vision
chart. Color vision was desaturated, light reflex is sliggish, RAPD were present.
• On slit lamp examination all findings were normal.
CONTI….
• On fundoscopic examination optic disc was Hyperaemic, indistinct
margin & obliteration of physiological cup in left eye. All branches of
vein was dilated & tortious, extensive flame Shaped & dot blot
hemorrhage, cotton wool spot were present in all four quadrant of left
eye. Foveal reflex was dull. Fundus of right eye was normal.
PROVISIONAL DIAGNOSIS
• Central retinal vein occlusion of left eye.
DIFFERENTIAL DIAGNOSIS
• Diabetic retinopathy
• Hypertensive retinopathy
INVESTIGATION
• Systemic :
• CBC
• RBS : 8.0mmol/l
• HbA1c
• Serum lipid profile
• ECG
• Ocular :
• CFP
• OCT (macula)
• FFA
CFP
• Disc is Hyperaemic
• Margin indistinct
• Obliteration of physiological cup
• Extensive dot blot flame shape
Hemorrhage
• Cotton wool spot
• Blood vessels dilated & tortous
OCT MACULA (LEFT EYE)
• Vitrio retinal interphase is normal
• Foveal conture is altered
• Multiple optically empty space within
the layer of retina.
• Retina is thickened in macula
• RPE – choroidal interphase is normal
CONFIRM DIAGNOSIS
• Central retinal vein occlusion of left eye.
TREATMENT
• Control of DM & HTN
• Immediate ocular management :----
• Intra vitrial Anti VEGF
• Intravitrial steroid
• Subsequent management :---
• Panretinal photocoagulation (PRP)
FOLLOW UP
