Optic Atrophy

Long Case Presentation
Dr. Md. Shahidul Islam Nurre

Resident, Phase-B
Department of Ophthalmology
Bangabandhu Sheikh Mujib Medical University
Particulars of the Patient :
Name : Mr. H.M. Nazrul Islam

Age : 45 years
Sex : Male
Religion : Islam
Address : Amtoli,Barguna
Chief Complaints
Headache for 3 years.

Reduction of vision in both eyes for 1 year.
History Of Present Illness
According to the patient’s statement he was

reasonably well 3 years back.Then he
developed headache which was global in
nature, moderate in intensity,occurred 1-2 days
interval but more in early morning,associated
with nausea & relieved by vomiting.
Contd..
For the last 1 year, he developed
reduction of vision of his both
eyes(Rt>Lt), which was gradual in nature,
not associated with any
pain,redness,discharge or colored haloes.
He has no H/O: using any spectacle,no
H/O: trauma,surgery or any previous
incidence of unconciousness or weakness
of any part of the body.
Contd..
He is nondiabetic, normotensive.His bowel
bladder habit is normal.
For this above complaints he visited to
NIO&H, Dhaka, took some conservative
treatment but not improved and referred to
BSMMU for better management
History Of Past Illness
No significant past history
Family History
He is married and has one son.None of her
family members has same type of illness.
Personal History
Govt service holder
 No history of smoking or drug abuse.
Loss of libido for the last 2 years.
Socioeconomic History
He belongs to middle class family and
lives in a brick built house with proper
sanitary facility.
Drug History
Tab. Neuro-B
1 tab daily for last 5 months
General Examination
Appearance : Normal
Body build : Average
Pulse : 78/min
BP : 110/70 mmHg
Temp : 98˚F
Resp/Rate : 16/min
Anaemia : Absent
Jaundice : Absent
Cyanosis : Absent
Clubbing : Absent
Cont..
Oedema : Absent
Lymph node : Not palpable
Neck Veins : Not engorged
Lymph nodes : Not palpable
Thyroid : Not enlarged
Skin condition : Normal
Hair distribution : Normal
Ocular Examination :
Right Eye Left Eye
Visual Acuity Distant-PL-PR Distant-3/60

With PH NI
Near-couldn’t be elicited Near :couldn’t be
elicited
Pupillary Light Reaction Direct : Present Direct : Present

Consensual : Present Consensual : Present
RAPD Present Absent
Hirschberg Reflex
Central Central
Ocular motility Full in all gazes Full in all gazes
Color vision Couldn’t be elicited Tri chromatic
Confrontation test Couldn’t be evaluated Restricted in all

quadrant
Right Eye Left Eye
Eye Lids & eye lashes Normal Normal
Conjunctiva Normal Normal
Cornea Transparent Transparent

Anterior Chamber Normal in depth both centrally & Normal in depth both
peripherally centrally & peripherally
Iris Normal Normal
Pupil Round, regular, reacting to light Round, regular, reacting

to light
Lens Clear Clear
IOP (on GAT) 10 mm of Hg 10 mm of Hg

at 1:15 pm
Fundus Examination
Right Eye:
Media : clear
Optic disc –
Margin : not well defined
Color : pale
Size :Normal
CD ratio : obliterared
NRR :
Small Blood vessels : Reduced in number

Background : Normal
Foveal reflex : Present
Left eye
Media : clear
Optic disc –
Margin : not well defined
Color : pale
Size :Normal
CD ratio : obliterated
NRR :
Small Blood vessels : Reduced in number

Background : Normal
Foveal reflex : Present
Other Systemic Examination
Nervous system
Patient is conscious & oriented
Higher psychic function: Intact
Cranial nerves: Intact
Motor function: Good
Sensory function: Intact
Cerebellar function: Intact
Signs of meningeal irritation : Absent
Cardio Vascular System:
Inspection: No scar mark
No visible apex beat
Palpation : Apex beat: present on left 5th intercostal
space medial to the mid-clavicular line
Thrill: absent
Percussion: Area of superficial cardiac dullness: Normal.
Auscultation: First and second heart sound audible NN

N
NoN added sound
No added sound.
Endocrine system : Normal

Respiratory system:
Inspection: Respiration - 16/min

Shape of the chest - Normal
Bilaterally symmetrical movement
on respiration
.
Palpation : Position of Trachea : Central
Percussion : Resonant
Auscultation: Vesicular breath sound
Salient Feature
Mr. H.M Nazrul Islam, 45 years old,
male,married,muslim,non diabetic &
normotensive hailing from Amtoli, Barguna
came to this department with the complaints of
headache for 3 years & reduced vision in both
eyes for 1 year. Headache was global in nature,
more in early morning,associated with nausea &
relieved by vomiting.His reduced vision of both
eyes was gradual & painless with no H/O :
trauma,surgery or using spectacle.
There is no H/O: unconciousness or
weakness of any part of body but H/O:
loss of libido for the last 2 years.
On general examination-his pulse was
78/min, BP-110/70 mmHg. Temp : 98˚F
Other vital parameters are normal.
Cont..
On ocular examination his VA :PL-PR in R/E &
3/60 with PHNI in L/E,RAPD present in
R/E,Confrontation test reveals restricted field in
all quadrant in L/E.
On Slit lamp examination: Anterior segment is
normal B/E ,IOP- 10mmHg in B/E by GAT.
On funduscopic examination : B/E reveals
features of Secondary optic atrophy. Other
systemic examination reveals no abnormality.
Provisional Diagnosis
Secondary optic atrophy of both eyes due to

Intracranial space occupying lesion
Differential Diagnosis
Primary optic atrophy B/E

Consequetive optic atrophy B/E
Investigation
RBS :5.8 mmol/L
S. GH : 0.05 ng/ml
S. Cortisol : 1.01/µgm/dl
S.T3 : 1.01ng/ml
S.T4 : 5.45µgm/dl
S. TSH :3.05 uIU/ml
S. Prolactin : >6580.00 ng/ml
S.Testosterone : 0.19 nmol/L
X-ray Skull lateral view
MRI of Brain
Management
Refer to department of Neurosurgery for
Surgical removal of the lesion followed
by histopathological examination
Regular follow up after surgery for
visual assessment.
Thank You

Optic Atrophy

Uploaded by

Copyright:

Available Formats

Optic Atrophy

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Optic Atrophy

Uploaded by

Copyright:

Available Formats

Long Case Presentation

Dr. Md. Shahidul Islam Nurre

Name : Mr. H.M. Nazrul Islam

Headache for 3 years.

According to the patient’s statement he was

Visual Acuity Distant-PL-PR Distant-3/60

Pupillary Light Reaction Direct : Present Direct : Present

Ocular motility Full in all gazes Full in all gazes

Color vision Couldn’t be elicited Tri chromatic

Confrontation test Couldn’t be evaluated Restricted in all

Conjunctiva Normal Normal

Cornea Transparent Transparent

Pupil Round, regular, reacting to light Round, regular, reacting

IOP (on GAT) 10 mm of Hg 10 mm of Hg

Small Blood vessels : Reduced in number

Small Blood vessels : Reduced in number

Auscultation: First and second heart sound audible NN

Endocrine system : Normal

Inspection: Respiration - 16/min

Secondary optic atrophy of both eyes due to

Primary optic atrophy B/E

You might also like