30y male with DOV in BE since 3 months.. no H/O trauma or any systemic illness.. ant seg wnl.. fundus pic attached
Larger whiter RNFL infarction ( cotton wool spots) with optic neuritis with CSME & superficial retinal hemorrhage bilateral involvement sexually active age highly indicates towards HIV neuroretinitis in both eyes. Patient needs to be well investigated and accordingly treated
RE : myelinated n.fibers & ? Lesion in macula . LE : cotton wool spots , & , superficial h'ge . Adv : f f angiography , ppbs , b.p measurement Also to investigate for Eale's disease .
We initially presumed it to be hiv microangiopathy as there were no vasculopathic risk factors like hypertension and diabetes.. but Elisa for HIV was negative.. so started steroids emperically as lesion appears like chorioretinitis
RE has juxtapapillary chorioretinitis.. LE has multiple chorioretinitis lesions.. according to senior faculty here.. started systemic steroids as all investigations were normal
Right eye is having MNFL LEFT EYE- multiple cotton wool spots along with serous fluid temporal to disc with flame hemorrhage These is mild dilatation of vein superior to macula Do a systemic evaluation Oct FFA arm to retina and early phases
Rt eye seems to be medullated nerve fibre n lt eye shows sum cottonwool spots n haemorrhages so cud b periphlebitis as age suggests. Adv him ffa
@Dr. Arun Rajan sir please help
RE medullated fibres.LE has cotton wool spots and sup haemorrhage- suggestive of ischemic etiology.r/o hypertension and carotid occlusion as changes are predominantly in one eye
Opaque nerve fibres
This patient had Ig M and Ig G positive for rubella on TORCH test
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A 42 y/o female complaint her vision was fuzzy and dark over the past 2 weeks. No complaint of pain and the eye has not become red or irritated. No past ocular surgery. Visual Acuity, with pinhole correction: Rt eye --20/30+2; Lt eye--20/200.
Dr. Vishal Kumar3 Likes14 Answers - Login to View the image
30 yr male presented with sudden painless dov in LE since 15 days.. he consulted elsewhere and was diagnosed with neuroretinitis with macular edema.. started on oral steroids along with nevanac eye drops.. came to us for second opinion.. On examination VA was CF 1 mt.. pupil reaction showed RAPD.. fundus pic attached.. any suggestions regarding investigations and further management?
Dr. Manbir Singh1 Like8 Answers - Login to View the image
OCULAR MANIFESTATIONS OF SLE. SLE is a chronic auto immune disease with multisystem involvement.SLE is multifactorial . Possible factors are genetic susceptibility, environmental factors and disturbances in both innate and adaptive immunity. Early detection and prompt referral to ophthalmologist can prevent permanent visual loss in some instances. OCULAR MANIFESTATIONS. SLE can affect any part of the eye and visual pathway.Eyelids ,orbit, lacrimal system , conjunctiva ,cornea ,sclera ,episclera ,retina , choroid ,uvea ,cataract ,glaucoma and cranial nerve are all involved. EXTERNAL EYE DISEASES : 1.EYELID DISEASE:Discoid lupus rash over the eyelids present as discrete raised scaly lesions. HPE shows hyperkeratotic epithelium with liquefactive degeneration of the basal layer and dense perivascular lymphocytic infiltration. ANA titre,ESR,C reactive protein,CBC,LFT,RFT Complement factors C3 &C4,anti phospholipid antibodies ,immunoglobulins,rheumatoid factor TSH,VDRL,GFR,24 hour urinary protein etc are the investigations necessary. 2.LACRIMAL SYSTEM DISEASE : Dry eye syndrome is the most common ocular presentation. 3.ORBITAL DISEASE. It can present as orbital mass,periorbital oedema ,orbital myositis,panniculitis,acute orbital ischemia and infarction. Clinical presentation can be ptosis,proptosis, orbital pain,limitation of extra ocular movements and enophthalmos. Treatment is by immunosupression. ANTERIOR EYE SEGMENT MANIFESTATIONS 4.CONJUNCTIVA : Chronic conjunctivitis is infrequent.Conjunctiva is inflammed in SLE associated keratitis and scleritis. Treatment NSAID or anti malarial therapy given. 5.CORNEAL DISEASE: Breakdown of corneal epithelium can cause recurrent corneal erosions.The inflammatory process in SLE causes PERIPHERAL ULCERATIVE KERATITIS. Treatment is with systemic corticosteroids and cytotoxic agent during acute phase of the disease and lubrication of corneal surface concommitantly.TOPICAL STEROIDS ARE NOT ADVOCATED AS THEY INHIBIT NEW COLLAGEN PRODUCTION AND THEREBY INCREASE THE RISK OF PERFORATION. 6.EPISCLERA : Episcleritis is benign inflammation of the episclera. 7.SCLERAL DISEASE : Scleritis is a painful and potentially sight threatening disorder.b ANTERIOR SCLERITIS presents as diffuse nodular or necrotising scleritis resulting in significant destruction and scleral thinning. Redness is caused by injection of deep episcleral vessels. POSTERIOR SCLERITIS :Affects the sclera posterior to the equator of the globe. presenting symptoms are pain and blurry vision caused by exudative retinal detachment papillitis and cystoid macular edema. Immunosupression is essential. 8.ANTERIOR UVEITIS Rare presentation.Prompt immunosuppressive therapy is considered. 9.CATARACT : Iatrogenic steroid use in SLE is associated with cataract formation. 10.GLAUCOMA : Open angle glaucoma and angle closure glaucoma are seen in SLE. POSTERIOR EYE SEGMENT MANIFESTATIONS 11.SLE RETINOPATHY. The earliest findings are small intra retinal hemorrhages and cotton wool spots,multiple areas of polygonal retinal whitening between the retinal arterioles and venules. Systemic therapy with steroids, Immunosupression ,laser therapy,intra vitreal anti-vascular endothelial growth factor agents (anti-VEGF) and vitrectomy are all treatments offered. 12.RETINAL VEIN OCCLUSION / RETINAL ARTERY OCCLUSION. Pathogenesis of vaso occlusive retinopathy is due to thrombosis associated with anti- phospholipid syndrome. 13.RETINAL VASCULITIS : This is a rare potentially blinding complication of SLE. 14 CHOROIDOPATHY : Choroidopathy with exudative retinal detachment is a rare ocular manifestation of SLE.It is manifested as multi focal serous detachments of the retinal pigment epithelium (RPE) and the neural retina ,with the transduction of the accumulated fluid through bruch's membrane and RPE affected by the choroidal ischemia and inflammation. The presenting feature is visual loss ,which depends on the extent of the macular involvement. 15. OPTIC NEURVE DISEASE: SLE can cause optic neuritis and ischemic optic neuropathy.The optic nerve damage is believed to be secondary to an occlusive vasculitis of the small arterioles of the nerve , which leads to demyelination and /or axonal necrosis. Signs of optic nerve disease. *Reduced visual acuity. *Impairment of color vision. *Diminished light brightness sensitivity. *Decreased contrast sensitivity. *Afferant pupillary defect. *Visual field defects. 16.CRANIAL NERVE INVOLVEMENT. Ocular motor nerve palsy can occur. MANY OCULAR COMPLICATIONS ARE PREVENTABLE,TREATABLE OR EVEN CURABLE.PROMPT TREATMENT WITH HIGH DOSE SYSTEMIC CORTICOSTEROIDS AND IMMUNOSUPPRESSIVE THERAPY ARE NECESSARY.
Dr. Suvarchala Pratap9 Likes15 Answers - Login to View the image
A 46 yrs female pt Recent complaint strain & blurring of vision But she awoke yesterday severally blurred vision in her left eye she states everything was normal when she went to bed last night . No pain no flashes no floater when she woke up she found she was unable to see anything but blurry color & light left eye no symptoms in the rt eye k/c/o Dm 2 since 12 yrs htn since 7 yrs ckd 3 stage recent creatinine 1.9 please suggest best opinion??
Dr. Ruqqaiya Khan1 Like13 Answers - Login to View the image
31 yr old ,F, from Maldives, No known medical conditions,presented with abrupt onset of sudden loss of vision on the left eye 1month ago..She denied having any pain in the left eye/ eyes.. No head ache ,no motor or sensory symptoms. On exam Bp130/ 70 mmhg. No external markers for vasculitis.Optic fundi picture is enclosed,top is the left ,lower is the Rt. No long tract signs. Initial treatment at Maldives,no improvement in vision.MRI brain and spine were done including MRA brain and also with contrast at Maldives reported as normal. Blood work up including screening for vasculitis were normal. Aquaporin-4 antibodies - ve. Diagnosis and management Ophthalmologist and Neuroligist
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