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Test Your Skills in Eye Casualty

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a Case 1 This patient presented with sudden loss of right vision. Examination  with an ophthalmoscopy revealed the above appearance.  What is the diagnosis? Answer Central retinal vein occlusion.  Note the diffused flamed haemorrhages affecting all  four quadrants and the optic disc is swollen.

Case 2 This patient complains of sudden onset loss of part of the  left visual field. Your ophthalmoscopic view was as shown in the picture above. What is the diagnosis? a Answer Branch retinal vein occlusion.  The flamed haemorrhages in this case is confined to the superolateral quadrant.

Case 3 This patient presented with sudden onset loss of the right upper visual field and decreased vision. What is the diagnosis? a Answer Branch retinal artery occlusion.  The infarcted retinal artery appears as white in the inferior retina.

Case 4 This patient complained of pain in the left eye. The pupil was irregular as shown. What is the diagnosis? a Answer Anterior uveitis or iritis. The picture shows posterior synechiae which resulted from attachment between the iris and the lens.

Case 5 This patient complained of floater and visual field loss. What is shown in the picture? a Answer Retinal detachment. The retina is elevated and appears darker than the normal retina.

Case 6 This patient underwent an uneventful cataract extraction and implant recently. He came to the casualty with severe eye pain in the operated eye. What is the diagnosis ? .a Answer Infective endophthalmitis. The picture shows hypopyon (ie. pus in the anterior  chamber). While this may occur in severe inflammation;  in post-operative patient this should be treated as infective endophthalmitis until proven otherwise.

Case 7 This patient presented with severe pain in the right eye and reduced vision. The pupil did not react to light. What is the most likely diagnosis? . Answer Acute angle closure glaucoma. A non-reactive semi-dilated pupil and reduced vision is strongly in favour of acute angle closure glaucoma.

Case 8 This patient sustained a facial injury as shown above. Before repairing the eyes, what two things would you like to do? . Answer 1. The patient's tetanus status should be assessed. 2. The eye should be examined for possible perforation.