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Q. Please diagnose and interpret the eye test findings.

Answered by
Dr. Kartik Panikkar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 03, 2018 and last reviewed on: Oct 09, 2018

Hello doctor,

I have a case file and I would like you to diagnose it and do the interpretation for each test and case history. I have uploaded a PDF file with all the tests and the questions that I want you to answer.

#

Hello,

Welcome to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity). I will now sequentially explain the results of each test to you.

The stereoscopic images of the right eye fundus and optic disc show an area of darkening inferiorly, suggestive of a retinal nerve fiber layer defect indicative of early damage. (This is better seen in the red-free images.)

The same area of damage is seen again in the OCT (optical coherence tomography) reports, both in the disc scan and the ganglion cell analysis.

Finally, this area of damage is confirmed on the visual field report. The darkened spots seen are suggestive of an early visual field loss called a nasal step that is commonly seen in glaucoma. (This will need to be confirmed in a second visual field report repeated two weeks to one month after the first test.

These investigations confirm the diagnosis of glaucoma in the right eye. However, since the recorded intraocular pressure is 18 mmHg, that is, within the normal limits, my main differentials, in this case, would be:

  1. Primary open angle glaucoma (will need a 24 hour diurnal IOP variation monitoring to confirm).
  2. Normal tension glaucoma (will need a full cardiac workup including an ECG, 2D echocardiogram, carotid doppler, 24 hour ambulatory BP monitoring and if possible, a sleep study to rule out obstructive sleep apnea).

The left eye appears normal as of now, but this condition can be asymmetric in its incidence. Hence, a regular clinical exam schedule supplemented with investigations is advised.

For more information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist

Hello doctor,

Many thanks for the details. What about history (hypertension and heart disease) and medication? Are there risk factors? Also, what is the management of this case?

#

Hello,

Welcome back to icliniq.com.

Any vascular disease (like hypertension or cardiovascular disease) is a risk factor for normal tension glaucoma and hence needs to be completely evaluated.

For more information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist


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