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- Oct 1, 2002
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CC: 65 y.o. man with complaints of painless, gradual loss of vision OS.
HPI: Patient complained of a painless, gradual loss of vision OS over several months. He saw an eye doctor and was diagnosed with angle closure glaucoma. He was sent to the U of Iowa for evaluation, treatment, and possible laser peripheral iridotomy (LPI).
PMH: healthy, no medications, and no FH of glaucoma.
Exam:
mRx: PLANO OU
Best corrected visual acuities: 20/20 OD, barely hand motion vision OS.
Pupils: >3.0 LU RAPD OS (very large).
EOM: full OU
VF (see below)
IOP: 19 mmHg OD, 71 mmHg OS
DFE: retina exam notable for normal macula, vessels, and periphery OU. Optic nerves: 0.4 C/D OD, almost complete cup OS (see photos below).
SLE: OD notable for 1-2+ nuclear sclerosis cataract, OS see photos below.
Gonioscopy: moderately open angles OU. Not occludable OU. (+) Sampolesi line OS.
GVF OD - Full Field
GVF OS with severe VF loss
Slit Lamp OS: moderate injection, no cells seen in anterior chamber
Slit Lamp OS: moderate corneal edema, and moderately deep anterior chamber
Slit Lamp OS: undilated pupil exam notable for white, fluffy material around pupil margin.
Slit Lamp OS: dilated exam notable for ground glass appearance of anterior lens capsule
Right Optic Nerve: normal
Left Optic Nerve: almost complete cup
Feel free to discuss the following:
What tests should you order (I'll post labs when asked for them)?
What's the differential diagnosis?
What's the diagnosis?
What is the treatment of choice, surgically and/or medically?
HPI: Patient complained of a painless, gradual loss of vision OS over several months. He saw an eye doctor and was diagnosed with angle closure glaucoma. He was sent to the U of Iowa for evaluation, treatment, and possible laser peripheral iridotomy (LPI).
PMH: healthy, no medications, and no FH of glaucoma.
Exam:
mRx: PLANO OU
Best corrected visual acuities: 20/20 OD, barely hand motion vision OS.
Pupils: >3.0 LU RAPD OS (very large).
EOM: full OU
VF (see below)
IOP: 19 mmHg OD, 71 mmHg OS
DFE: retina exam notable for normal macula, vessels, and periphery OU. Optic nerves: 0.4 C/D OD, almost complete cup OS (see photos below).
SLE: OD notable for 1-2+ nuclear sclerosis cataract, OS see photos below.
Gonioscopy: moderately open angles OU. Not occludable OU. (+) Sampolesi line OS.
GVF OD - Full Field
GVF OS with severe VF loss
Slit Lamp OS: moderate injection, no cells seen in anterior chamber
Slit Lamp OS: moderate corneal edema, and moderately deep anterior chamber
Slit Lamp OS: undilated pupil exam notable for white, fluffy material around pupil margin.
Slit Lamp OS: dilated exam notable for ground glass appearance of anterior lens capsule
Right Optic Nerve: normal
Left Optic Nerve: almost complete cup
Feel free to discuss the following:
What tests should you order (I'll post labs when asked for them)?
What's the differential diagnosis?
What's the diagnosis?
What is the treatment of choice, surgically and/or medically?