Authors:
Diego Paredes Jalil M.D: Pediatric Ophthalmology and Ocular Genetics. Pontificia Universidad Católica de Chile. Former Fellow Flaum Eye Institute-University of Rochester, New York.
Luis Peña Garcia M.D Neuro-ophthalmology. Pontificia Universidad Católica de Chile
A 35-year-old man presents with a history of poor vision in both eyes since he was 18 years old. Past medical history is unremarkable except for a serious head injury when he was 6 years old, but his vision was normal afterward until the onset of this new problem. Family history reveals that his mother has poor vision from an undetermined cause.
Examination shows a visual acuity of 20/150 right eye and 20/200 left eye. Pupillary responses are normal, with no afferent pupillary defect. Ocular motility is normal. He can only see the control plate on Ishihara color testing. Anterior segments are unremarkable. Intraocular pressure is 20 mmHg in both eyes. Brain and orbit MRI are normal.
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normal pupil response tho’
Yes pupil responses stay “normal” clinically because a large part of the retina and optic nerve is still functional even if the macular fibres are affected.
Pupillometry can detect a reduction in amplitude, just that it isnt clinically very obvious
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This case can broaden the clinical differential diagnosis range, and a key feature is the characteristic temporal wedge-shaped ONH atrophy. It is not a glaucoma case, not a pituitary lesion, nor an IRD.
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thank you once again. Hope to see few more mails on quiz like these and strabismus as well.
Regards,
Dr. Sarath Chandra Bandreddi,
Consultant Ophthalmologist,
Dept of Pediatric ophthalmology, Strabismus and Neuro ophthalmology,
Vijayawada,
Andhra pradesh, India
M: +91 8885895425
There was a serious head injury in childhood. How is this related?
This is a case of maculopathy since theretinal and optic nerve fibers are being spared and stil intact
A very informative case. Thanks a million ♥️
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