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Case Presentation
CASE
Patient Profile
Name
Age Gender
Residence
Occupation Presented on
Presenting Complaints
Gradual deterioration of vision for last 8 years in both eyes
Diabetes 1 Month Hypertension Asthma Peripheral Vascular Disease NAD IHD Heart failure/Block Hepatitis
Drug History
Tablet Metformin and Glibenclamide BD 0.5% levobunolol 1 drop BD No known drug allergies
Personal History
House-wife, no h/o substance abuse
Family History
No glaucoma or ocular or systemic disease
Examination
NAD
Systemic Examination
NAD
Ocular Examination
Right eye
6/12 6/6 partial
(+2.50DS/-1.5DCx90)
Left eye
Visual acuity best corrected visual acuity Pin hole Near vision Colour vision Visual fields (confrontation method) Extra ocular movements 6/18 6/6 partial
(+3DS/-1.5DCx90)
normal
normal
Right eye
normal normal normal Deep/formed Round, regular, reactive Adnexa Conjunctiva Cornea Anterior Chamber Pupil
Left eye
normal normal normal Deep/formed Round, regular, reactive
clear
Lens
clear
Right eye
15 IOP
Left eye
16
normal normal
Vitreous Retina
normal normal
Ocular Examination
Right Eye Left Eye
Gonioscopy
Right eye Left eye
11 1
1v 11 1 111
111 111 1v
Visual Field
Investigations
Pachymetry (micrometre)
Right eye
Left eye
551
554
Provisional Diagnosis
Primary Open Angle Glaucoma
Management
Primary aim is to lower and maintain intra-ocular pressure (target pressure) Monitoring of optic nerve and visual fields
Medical Therapy
0.5% levobunolol 1 drop BD
Follow up
Counseling:
Regular and meticulous use of medications Screening of family members
Monthly:
IOP measurement Visual acuity C/D ratio
Annually
Gonioscopy Visual field assessment OCT (optic nerve fibre layer thickness)
THANKS