Retinitis case

8/2/2019 Retinitis case

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Case Presentation

-Dr.Prathibha.M.C


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Balaji .P ( OP: 1OP738997) 27 years, male, driver by occupation from Bangalore.

Seen on 27/2/2012 and 29/2/2012 in sector OPDFrom 7/03/2012 @ retina clinic


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Chief Complaints

On 27/02/2012 Difficulty while driving since 2 days

Left eye decreased vision -2 days Left eye pain and redness- 2 days


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History of presenting illness Patient was apparently alright when he started having pain and redness

associated with decreased vision which hampered his driving and heapproached the eye doctor for the same.

Decrease in vision- insidious in onset for both distance and near, and nonprogressive , associated with pain , no increase in pain with movement of

eyes Pain was insidious in onset dull aching and constant , non radiating ,no

associated headache or nausea or vomiting /no tinnitus/flashes of light/floaters

Redness was not associated with any discharge/itching/watering

No- h/o trauma; h/o usage of contact lensesh/o long term eye ocular medicationsh/o ocular surgery

No h/o similar complaints in other eye /in the past


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History of presenting complaints H/o fever and myalgia, associated headache for which he was admitted in

the general hospital for 1 week in the month of January first week- No h/o rashes/joint pain/nausea or vomiting No h/o any blood transfusion/cough with

expectoration/diarrhoea/constipation/convulsions No h/o weight loss No h/o using any long term medication in the past for any systemic

illnesses


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Personal history and family history Unmarried; mixed diet Dyslexia+

Past medical and ocular historyAdmitted recently for fever with myalgia and headache- investigated for thesame

No significant ocular history

Treatment history :during the stay in hospital was given IV ciplox

BD and IV metrogyl TID for 5 days with fluid replacement IV for 5 daysfollowed by oral ciprofloxacin for 2 weeks with NSAID and vitaminsubstitute; investigated with baseline blood tests and urine and stoolsexamination.


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General physical examination

Moderately built well oriented to time place and person

Height-6 feetWeight-68 kgs

Pulse-76/min ; afebrileBlood pressue:126/68 mmhg


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Ocular examinationRight Eye Left eye

Vision- UCVA- Distance 6/6 Pl+/Pr- accurate/HM+/CF- 1 meter ; pin hole - NI

Vision UCVA- near N6 nil

Color vision normal Not possible

Extraocular movements-ductions and versions

normal normal

IOP- Perkins 12 mmhg 6 mmhg

Head posture normal

Facial symmetry normal

Ocular symmetry normal

Lids and adnexaLacrimal sac area

NormalRoplas -ve

NormalRoplas -ve


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Right Eye


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Right Eye


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Right Eye


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LEFT Eye


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LEFT Eye


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LEFT Eye


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Ocular examinationRight eye Left eye

Conjunctiva-bulbar andforniceal

Normal Circumciliary congestion +

Cornea-sizeShapeTransparencysensation

normal ClearNo edemaNo KPNormal sensation

Anterior chamber depthcontent

normal +2 cells+2 flare; single fibrinousstrand+ at the pupil edge

Iris & Pupil- positionsizeShapeReaction to light:direct andindirect

NormalNormalNormalPresent and brisk

NormalIrregular from 6k to 10k Sluggishly reactive

Lens Clear and normal Clear; syneachia and pigmentdeposition+

Anterior vitreous(retrolental) Clear and normal +2 cells


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Fundus examination

78D Indirect ophthalmoscopy


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Provisional diagnosis

Right eye: normal Left eye: Panuveitis with Neuroretinitis (acute

and insidious)


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Differential diagnosis Acute febrile illness Chronis tuberculosis;syphillis;mycotic

infection;parasitic(tenia) Retinal periphlebitis (?eales)

Leptospirosis Lymes(borrelia burgdoferi) Bartonella hensale Rickettsia (r.Rickettsia;tsusugmushi)

Toxoplasmosa retinitis Toxocara Cytomegalovirus retinitis Behcets disease


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Investigations

Blood tests- complete blood count with smear Chest x-ray Mantoux test VDRL HIV-ELISA Weil Felix test Fundus fluorescein angiogram Optical coherence tomography


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FFA Choroidal phase

Arterial phase Early Arterio venous phase Arteriovenous phase

Late arteriovenous phase Recirculation phase


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Choroidal phase


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Arterial phase


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Early AV phase


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AV phase


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Late phase


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Periphery noe/o sheathingor nve


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Optic disc staining pattern


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Right eye


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Treatment

Tab Azithromycin 500 mg BD 1 week Tab Doxycycline 100 mg BD 2 weeks. Tb.Wysolone:60mg 1week tapering dose for

next 6 weeks Topical : Homide e/d TID

Predmet e/d 1hourly 1 week tapering

12/8/6/4/3/2Oflacin e/d 4t/day


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10 days after azithromycin


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Retinitis case

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