Best Cases of Curofy - Ophthalmology

Rare, complicated and intriguing cases

come across the career of a doctor not more than
once in a lifetime. These cases are often the
stepping stone of learning and evolution in
medicine and healthcare.
These interesting cases broaden the
perspectives of a doctor not just in medicine
but in overall patient healthcare.
Curofy, brings to you a concise compilation of
such top cases in the field of Ophthalmology
contributed by various doctors across the country.

Best Cases of Curofy - Ophthalmology

Case 1:
4-5 days history of swelling of eyelid. spot diagnosis??
Dr. Ishan Verma
Internal Medicine

Best Helpful Answer

External hordeolum (stye) Its a localised infection of zeiss or moll
sebaceous glands.. Most of them are due to staph.aureus infection..
If patients has fever with auricular lymph nodes cellulitis is another
possibility. . If there are no systemic symptoms than need only Hot
fomentation Topical ointment bacitracin or chloramphenicol in night
and ciplox eye drops in day time. Nsaids can be given for pain and to
reduce inflammation. . If there is pus pointing than needs drainage. .
If systemic symptoms are present like fever, palpable local lymph
nodes treat with oral antibiotics erythromycin or amoxi-clav..
- Dr. Azhar Moid
Top Internal Medicine Practitioner of October

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Best Cases of Curofy - Ophthalmology

Case 2:
At what magnification you guys are doing phaco. I'm doing it at 8x.
I have seen people doing it at 5-6x also. What do you think is
preferable. Please suggest.
Dr. Ravi Kant Bamotra
Ophthalmology

Best Helpful Answer

Yes it absolutely depends at the step we do . I prefer 6x for all the
steps and adjust the fine magnification depending on the needs. In
case suturing required i switch to 4x due to better visibility of the
suturing site
- Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Case 3:
8 yr old male child with OU 6/9 vision, NIPH, anterior segment
wnl..fundus and Oct picture attached. 1. Diagnosis 2. Management
Dr. Nidhi Tiwari
Ophthalmology

Best Helpful Answer

appears to be congenital retinoschisis which usually presents around this age
with bilateral bicycle wheel pattern maculopathy...also oct shows cyst like
spaces..associated with peripheral schisis in 50% patients mostly infero
temporal..visual acuity deteriorates during first 2 decades than stabilizes til 6th
decade..no treatment just keep on follow up to detect and treat complications
like vitreous and intraschisis hmg..retinal detachment..
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Dr. Ankita Chaudhary

Best Cases of Curofy - Ophthalmology

Case 4:
This is in response to a doubt raised by Dr Himani about PRE PERIMETRIC
GLAUCOMA. It's important that every Ophthalmologist is aware of this entity and
how to manage it. This is a condition that gained importance with the advent of
technologies such as GDx, HRT, OCT and other perimetric techniques such as
SWAP and FDT. To put it in simple terms, preperimetric glaucoma is glaucoma
with Normal White on white perimetry. IOP may be normal or slightly raised Disc
may be Clinically normal or show early Glaucomatous changes like early notch,
disc hemorrhage, RNFL defects, cdr assymmetry White on white perimetry is
normal The term is usually used for open angle glaucoma (at least the cases I have
come across are all open angle). But I guess it can also occur in cases with narrow
angles (Primary Angle closure suspects and Primary Angle closure patients) As the
glaucoma is in a very early stage, Abnormalities will usually be seen on the HRT,
GDx and OCT print outs. SWAP and FDT may also be abnormal. All these
techniques help us to identify any change in the optic disc rim or peripapillary
nerve fibre thickness. In the case of SWAP and FDT, any early ganglion cell damage
may be picked up. So as u can see the condition can be very easily missed as it
can present with a normal IOP and disc. Therefore, if there is normal or suspicious
disc or RNFL defect with normal HFA 30-2 or 24-2, and the patient has risk factors
for glaucoma like family history, raised IOP, low CCT, disc hemorrhage, cdr
assymmetry, Myopia, etc then an OCT, GDX, HRT , SWAP or FDT (depending on
availability. Most of us would have access to one of these at least) must be
performed to rule out PRE PERIMETRIC GLAUCOMA. I prefer using the OCT
personally and it is the most commonly used technique. SWAP and FDT are the
least commonly used modalities. A word of caution: It is true that these modalities
can pick up any early thinning of the rim or RNFL, but they cannot be used in
isolation and they are certainly not a substitute for fields or your clinical acumen.
Always correlate the results from these modalities clinically.

Dr. Arun Rajan

Top Ophthalmologist of October

Its an educational post

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Best Cases of Curofy - Ophthalmology

Case 5:
70yr patient came with sudden decrease in vision RE , what is
diagnosis and modalities for treatment
Dr. Deepinder Sandhu
Ophthalmology

Best Helpful Answer

The left eye seems to have soft Drusens. So I'm guessing the right eye
has a CNVM with a sub retinal bleed causing the sudden vision loss.
- Dr. Arun Rajan
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Case 6:
Stuck up with one step in cataract surgery.. I have done 3 pcr while
doing irrigation aspiration. Please help me with some tips.
Dr. Neha Arora
Ophthalmology

Best Helpful Answer

What surgery are you doing? ECCE, SICS or phaco? 1. Its slightly
tough to do IA in ECCE and SICS. The simcoe cannula should be be
very good. Else PCR is very common. I am sure if are a beginner and
doing mature cataracts then there is usually not much of cortex left.
First put the lens and rotate it in the bag. The cortical matter loosens
up and then do a IA. The chances of PCR decrease plus you IOL goes
in the bag. 2. Phaco its not very tough to do IA as you two well sealed
ports which help maintain the chamber well. Also for a good IA
hydrodissection should be done properly And dont worry about IA.
Even if u leave mild cortex after your initial surgeries. Try putting IOL
in the bag and give post op steroids. Good luck
- Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Case 7:
Diagnosis.. Explain the disc and b scan findings...
Dr. Nidhi Tiwari
Ophthalmology

Best Helpful Answer

On seeing the disc in isolation, I would say it is disc edema, but the b
scan will never show reflectivity at the disc if this was the case. The
most common cause of this appearance on b scan is a disc Drusen.
So now going back to the disc and examining more carefully, u notice
the Drusens are actually visible at the nasal and superonasal margins
of the disc.(I'm assuming this is a left eye disc) So now this becomes
a case of pseudo papilledema due to disc drusens
- Dr. Arun Rajan
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

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Case 8:
12 year old girl with mass in the right eye since 2 weeks. On
examination Lid edema present Conjunctival chemosis Yellowish
white cystic Mass arising from supernasal fornix and extending upto
the medial canthus. Pupil NSNR Fundus WNL USG picture attached 1.
Diagnosis 2. Treatment
Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Best Helpful Answer

1. Cysticercosis 2. treatment: a) surgical excision of the
Subconjunctival cyst. b) start on albendazole 15mg/kg/ day for 4 wks
c) oral prednisolone 1mg/kg/day for 15 days then tapper over 15
days d) LFT shd be done prior to therapy and during therapy
-

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Dr. Nidhi Tiwari

Best Cases of Curofy - Ophthalmology

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Case 9:
This for doubts regarding identification of macular split on HFA
printout. I am posting 2 printouts, a 24-2 and a 10-2 (they don't belong
to the same patient) First consider the 24-2 print out. In the raw data
( the one next to the greyscale), look at the central four values. U will
notice that the superonasal value is 0. This is an indication that there
MAY BE macular involvement (but we r not sure yet). If none of these
points are 0, we can RULE OUT macular involvement. As u all know the
24-2(in which central 24 degrees of field charted through 54 test
points) has a bare area of 3 degrees ( ie when u do a 24-2, the central
3 degrees of the field is not tested). Therefore even if one or more of
the central points in the raw data of a 24-2 is 0, it DOES NOT
necessarily mean that the macula is involved. To confirm macular
involvement, we have to check the field in this bare area. This is where
the 10-2 test comes in. The 10-2 charts the field of the central 10
degrees(68 test points) and has a bare area of 1 degree only. Look at
the central 4 points in the raw data. If any one of these points is 0,
then MACULA IS INVOLVED (as in the 10-2 print out I have posted). If
none of these points is 0, there is no macular split. Of course, the
lesser the decibel values in this area, the more the risk of wash out
post surgery. This part of the field usually has the highest decibel
values, so any low values here should make u alert. When a washout
or wipe out does occur, then all these 4 central values will become 0
or <0. Pls note: if u are getting values lesser than 0 like <1 or <2
anywhere on the field, it indicates that ur perimeters bulb is weak and
needs to be changed. Now the , macular program gives us no
additional information when compared to the 10-2. It's advantage is
that it only measures the central 16 points of the 10-2 and therfore
takes lesser time. It's useful for patients with very advanced glaucoma
where u just want to know the macular status.
Dr. Arun Rajan
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Best Helpful Answer

wonderful post sir..it cleared all my doubts on the topic.. I am sure it
is very useful for all the post graduates.. many thanks for this one sir..
-

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Dr. Nidhi Tiwari

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Best Cases of Curofy - Ophthalmology

Case 10:
8 year old boy with swelling since the age of 1 year. it is gradual
painless and progressive. 1. Differential Diagnosis 2. Treatment
Dr. Neha Mehrotra
Top Ophthalmologist of October

Best Helpful Answer

most probably Dermoid cyst. Not originating from lacrimal as that
will cause an S shaped eye lid margin.
- Dr. Arun Rajan
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Case 11:
Operated a phacomorphic last week. The IOP is still uncontrolled and
fluctuating ~ 40 with maximum anti-glaucoma therapy. Post op fundus
examination shows CRVO. How to proceed further and achieve IOP
control ?
Dr. Ravi Kant Bamotra
Ophthalmology

Best Helpful Answer

Well, if the AC is of normal depth, then the reason for the high IOP
may be severe post op inflammation or open angle stage of NVG.
Examine carefully under high magnification for NVI when the pupil is
not dilated. Do a gonioscopy to look for angle neovascularisation and
early PAS. If it is severe inflammation, then increase the frequency of
steroids and give systemic steroids, topical cycloplegics, topical IOP
lowering medications too. Be on the look out for development of
neovascularisation. I think its is a bad idea to do a Trabeculectomy
with Mitomycin in these cases as the chances of the bleb failing are
very high when inflamed aqueous enters it. If there is already
evidence of neovascularisation, then u will have to go for PRP or Anti
VEGF agents in addition to the above. (after decreasing the IOP and
controlling the inflammation). Try to get this done as soon as possible
because if the neovascularisation subsides, most of ur problems will
be solved. Again planning a trabeculectomy so soon after cataract
surgery is a bad idea... it's better to wait for at least 3 months in my
experience.
- Dr. Arun Rajan
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

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Case 12:
67 year old with diminution of vision in right eye since 6 months. No
history of DM/HTN. Taking treatment for open angle glaucoma OU
brimonidine 0.15%BD Examination OD FC 2m OS 6/36 Fundus picture
,FFA and OCT attached 1. diagnosis 2. line of management
Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Best Helpful Answer

RE: CNVM LE: Partial thickness macular hole CNVM can be managed
by Inj Anti -VEGF or laser. Medically treatment is not encouraging but
AREDS formulation can be given along with. Lamellar macular hole
can be left as it is. PPV+fluid-gas exchange can be done in progressive
condition.
-

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Dr. Ratnesh Kumar

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Best Cases of Curofy - Ophthalmology

Case 13:
45 year old lady with complaints of headache since past 8 months On
examination OU 6/6 Pupil NSNR lens clear fundus BE disc hyperemia
with blurring of disc margins 1. Diagnosis 2 MRI findings
Dr. Neha Mehrotra
Top Ophthalmologist of October

Best Helpful Answer

1. Idiopathic intracranial hypertension 2. MRI - T 2 w axial section
showing flattened posterior sclera, tortuous optic nerve, prominent
perioptic sybarachanoid space...and probably empty sella and no
other mass lesion for secondary intracranial hypertension
-

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Dr. Nidhi Tiwari

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Best Cases of Curofy - Ophthalmology

Case 14:
plz spot diagnosis and treatment?
Dr. Kumar Krishnan
Ophthalmology

Best Helpful Answer

malignant melanoma nodular variety.
- Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Case 15:
35 yr woman presented with redness and protrusion of RE since 3 months..
examination revealed RE eccentric proptosis, congestion on medial side,
vision was 6/24 not improving. USG, Fundus photo and MRI scan attached..
appears like an extraconal mass lesion.. radiologist suggests a choroidal
melanoma.. any suggestions regarding DD

Dr. Manbir Singh

Ophthalmology

Best Helpful Answer

I can think of two possibilities 1. Medial rectus cysticercosis 2. Myositis of
the the medial rectus (NSOID) Definitely not choroidal melanoma
- Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

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Case 16:
25 yr male with complaints of DOV in RE since 15 days.. he had intravit
triamcinolone injected at some center in RE 12 days ago.. he also had
DOV in LE since 8 days for which he had subtenon traimcinolone at a
different hospital.. now he came to us with VA of 6/36 in RE and 6/9p
in LE.. mantoux was weakly positive.. chest xray wnl.. elisa for HIV non
reactive.. OCT shows macular edema in RE.. we started ATT after
consulting with pulm med dept along with systemic steroids and
topical nsaids suspecting eales with venous occlusion with macular
edema.. he cant afford lucentis.. any suggestions regarding DD and
management?
Dr. Manbir Singh
Ophthalmology

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Best Cases of Curofy - Ophthalmology

Best Helpful Answer

Right eye fundus : media appears clear Mild disc pallor present
vascular sheathing seen in ST and IT arcade suggestive if periphlebitis
dot blot haemorrhages seen in all the quadrants macular star seen
Left eye Again vascular sheathing noted in the superotemporal
quadrant with multiple haemorrhages leading to an appearance of
Inflammation induced ST BRVO Case looks like of vasculitis or
commonly referred to as eales disease. Treatment will include 1. ATT
2. oral steroids. 3. PST in right eye as he has inflammation induced
macular edema. 4. Do FFA to check for any areas of NVE. Laser the
ischemic retina ie in case u note CNP areas as complaince is an issue
with these patients and they come with VH if not lasered Case look
- Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

Case 17:
Both eyes showed the above picture in a 35 years old male.
Diagnosis?
Dr. Sushma Ravuri
Ophthalmology

Best Helpful Answer

Looks like corneal dystrophy most likely stromal. Mostly Granular
corneal dystrophy
- Dr. Neha Mehrotra
Top Ophthalmologist of October

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Best Cases of Curofy - Ophthalmology

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