12/11/

13

Clinical
Case
Presentation

Dr. M.I.
Magdum

Moderator :

Patients Details
Name : LSB
Age: 58 yrs.
Sex Male
Occupation: Farmer
Resident of: Nippani

11/28/16

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Presenting Complaints
Diminution of vision in
Right Eye since 2 months.
Single episode of pain in
Right Eye 1 month ago.

11/28/16

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History of Present Illness

Patient was apparently alright until 2
months ago when he started developing
diminution of vision in Right Eye which
kept on progressing gradually and
painlessly.
He first noticed it while working in the
fields one day that he was unable to
recognize faces infront of him with left
eye closed, his vision in the right eye
has progressively been diminishing
since.
11/28/16

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History of Present Illness

About one month ago the patient
experienced an episode of pain in the right
eye sudden in onset, pricking in character,
non radiating for which he consulted a local
doctor who gave him some eyedrops to be
put hourly and spectacles.
The pain resolved within 2 days but the
diminution of vision has progressed such
that since the past 15 days he is only able
to see objects less than 1m away.

11/28/16

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History of Present Illness

No
No
No
No
No
No
No
No

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h/o
h/o
h/o
h/o
h/o
h/o
h/o
h/o

redness
watering
discharge
colored halos
micropsia
metamorphopsia
flashes of light
curtain falling infront of eyes

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History of Present Illness

h/o cough since 5 months present
No h/o weakness
No h/o tiredness
No h/o lethargy
No h/o weight loss
No h/o sore throat
No h/o fever
11/28/16

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History of Present Illness

No h/o burning micturition
No h/o ocular trauma
No h/o convulsions
h/o tobacco intake present

11/28/16

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Past History
Patient has history of dysphonia since the
past 5 months for which he showed a local
doctor in Nippani, he was told that it will
improve with medications, but there was
no improvement. At the same time
patients developed cough which is not
continous, comes in bouts and has no
aggravating or relieving factors. The cough
has been persisiting for the last 5 months.

11/28/16

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Past History
A few days later, at KLESH the patient
underwent an endoscopy and was
diagnosed to be having right sided
vocal cord palsy.
He was prescribed a B-Complex, an
antibiotic tablet (Levofloxacin) for 5
days and a cough syrup.
It has now progressed to involve both
recurrent laryngeal nerves such that
the patient has no phonation at all.
11/28/16

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Past History
No history of similar complaints in
the past.
No h/o Diabetes Mellitus
No h/o Hypertension

11/28/16

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Personal History
Diet : Vegetarian
Appetite: Normal
Sleep: Not distubed
Bowel habits: Unaltered
Bladder habits: Unaltered
Substance abuse: Tobacco chewing
since 25 years. ( 1 packet for 3 days)
occasional alcohol intake

11/28/16

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Family History
No history of similar complaints in
the family.
Patient has 4 brothers and one
sister all of who are alive and
healthy.
His father passed away 20 years
ago due to chronic tuberculosis.
His mother is alive and healthy.
11/28/16

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Examination
Patient is an elderly male, poorly
nourished, conscious, co-operative
and well oriented to time, place and
person.
Pulse Rate: 90/min
Blood Pressure: 110/70 mm Hg
Respiratory Rate: 24/min
Afebrile to touch.
11/28/16

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Examination
No
No
No
No
No

11/28/16

evidence
evidence
evidence
evidence
evidence

of
of
of
of
of

Pallor
Icterus
Clubbing
Cyanosis
Lymphadenopathy

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Examination
Respiratory System: Bilateral equal air
entry
No adventitious sounds
heard
Cardiovascular System: Normal S1, S2
heard. No
murmurs
Per Abdomen: Soft, non tender
No distension
Bowel sounds present
.

11/28/16

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Examination
Central Nervous System: Higher
Mental functions intact
Dysphonia present.
On examination both side Vocal
chords are fixed.

11/28/16

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Ocular Examination
Head Posture : Erect
Facial symmetry: Symmetrical
Ocular Posture: Normal
Extra-ocular movements

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Visual Acuity

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+ 3.00

+2.00

+ 3.00

Sph
CF mt
Nil

-----

Cyl

+2.00

Axis

Sph

Cyl

Axis

---

--

+1.25

---

--

6/36

---

--

+4.25

---

--

N-36

Intraocular Pressure
Intraocular pressure{with Schiotz
tonometer (using 5.5g weight) on
12.11.13 at 08:40 a.m.} RE -12.2 mm of Hg
LE -14.6 mm of Hg

11/28/16

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Color vision
Patient is color blind

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22

Anterior Segment- OD

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Anterior Segment- OD

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Anterior Segment- OS

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Anterior Segment- OS

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Anterior Segment- OS

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Posterior Segment -OD

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Posterior Segment -OD

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Posterior Segment -OS

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Posterior Segment -OS

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Fundus Flourescein Angiography

OD 00:12 min
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Fundus Flourescein Angiography

OD 00:18 min
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Fundus Flourescein Angiography

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OD 00:22 min34

Fundus Flourescein Angiography

OD 00:28 min
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Fundus Flourescein Angiography

OD 00:56 min
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Fundus Flourescein Angiography

Os 01:24 min
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Fundus Flourescein Angiography

Os 01:24 min
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Fundus Flourescein Angiography

OsOs01:24
min
13:56
min
11/28/16

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B SCAN- OD

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11/28/16

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OD
Lens echo noted
Vitreous shows few low reflective
dot echoes
A mass lesion noted in the
peripapillary area and posterior
pole measuring 12.4 x3.5 mm with
high surface reflectivity and
variable internal reflectivity
Retinal detachment noted inferior
and temporal to the lesion
11/28/16

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OD
Retina attached elsewhere
Choroidal thickness normal
elsewhere
Optic nerve head appears
normal

11/28/16

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B SCAN-OS

11/28/16

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OCT- OD

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OCT- OD

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Investigations
Haemoglobin
12.6 gm%
Total Leucocyte Count 2300/cmm
Differential Leucocyte Count N72L25E02M01
Packed Cell Volume
40.6%
Platelet Volume
3.68lacks/cmm

Reticulocyte Count
Red Cell Count

0.2%

5.29million/cmm
11/28/16

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Peripheral Smear- Normocytic

hypochromic anaemia with

leucocytosis
Bleeding Time:
Clotting Time:

2:30 min
4:00 min

ESR 06 in first hour

11/28/16

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Urine Microscopy- Within

normal limits
No evidence of Albumin
or Sugar
HIV negative.

11/28/16

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Liver Function Tests:

Total Bilirubin
0.5 mg/dl
Direct Bilirubin
0.2 mg/dl
Total Proteins
7.2 gm/dl
Serum Albumin
3.8 gm/dl
A:G ratio
1.1
SGOT
16 U/L
SGPT
10 U/L
Alkalline Phosphatase 558 IU/L
11/28/16

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Renal function Tests

Urea:
Creatinine:

11/28/16

22 mg/dl
0.8 mg/dl

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Lipid Profile
Cholesterol
LDL Cholesterol
HDL Cholesterol
Triglycerides

11/28/16

192 mg/dl
120 mg/dl
50 mg/dl
111mg/dl

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X- Ray Chest P-A View

Hilar shadows are within normal limits.
Pulmonary vasculatures appear normal.
Both domes of diaphragm are smooth.
Both costophrenic recesses are clear.
Lung fields appear normal.
Visualized bones and soft tissue shadows
appear normal.

11/28/16

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Thankyou.
11/28/16

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