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53-year-old man was seen in the office on 2/10/2009. He was hit in a motor vehicle/pedestrian accident on November 10, 2008 at 10:45 p.m. He was taken to a trauma center where he was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. He has recovered, is out of the hospital, and remarkably doing fairly well. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. VISUAL ACUITY: Vision OD is 1/200, OS is 20/20. IOP: 15 OU. SLIT LAMP EXAM: There is an afferent pupillary defect in the right eye. There is 1+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. The nerve is pale. There is no posterior vitreous separation. The macula and periphery look healthy. OS: Vertical C/D ratio is 0.2. There is an unusually yellow subhyaloid hemorrhage superior to the fovea just barely touching the fovea, and there is also a vitreous floater which does often obscure the macula. The peripheral retina looks fine. OCT SCAN: There is a nerve fiber layer thickness in the right eye of 59 microns and left eye of 111 microns. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows hypofluorescence in the area of the yellow spot superior to the fovea, confirming it is preretinal. The right eye has normal flow on the angiogram. IMPRESSION: 1. SUBHYALOID HEMORRHAGE – LEFT EYE 2. VITREOUS HEMORRHAGE – LEFT EYE 3. OPTIC ATROPHY – RIGHT EYE DISCUSSION: I explained to the patient the left eye does have a clearly visually significant subhyaloid hemorrhage and vitreous hemorrhage, however, given that his straight ahead vision is 20/20 and the left eye is now his better eye, I suggested we leave the eye alone. Almost ninety percent of the time, blood in the eye does reabsorb. It is unusual there is this much blood in the eye three months after the injury, but I think probably after the injury, there was much more than this. He will return for check in six weeks. Fortunately blood in the vitreous or preretinal does not damage the retina, so there is no harm in waiting, and if this does not reabsorb over a reasonable amount of time, which may be as much as six months, I think it would be reasonable to consider vitrectomy. He will see you back regularly and return here in six weeks.

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Old Subhyaloid - Preretinal Hemorrhage (Yellow) 201 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 00000
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Old Subhyaloid - Preretinal Hemorrhage (Yellow) Traumatic Optic Neuropathy357 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 00000
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Old Subhyaloid - Preretinal Hemorrhage (Yellow) - Traumatic Optic Neuropathy252 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 00000
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Old Subhyaloid - Preretinal Hemorrhage (Yellow) 238 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 00000
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Old Subhyaloid - Preretinal Hemorrhage (Yellow) 145 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 55555
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Old Subhyaloid - Preretinal Hemorrhage (Yellow) 183 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 00000
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Old Subhyaloid - Preretinal Hemorrhage (Yellow) 136 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 00000
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Old Subhyaloid - Preretinal Hemorrhage (Yellow) 141 views53-year-old man 3 monts previous was hit in a motor vehicle/pedestrian accident and was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. OD is 1/200, OS is 20/20. 00000
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53-year-old man was seen in the office on 2/10/2009. He was hit in a motor vehicle/pedestrian accident on November 10, 2008 at 10:45 p.m. He was taken to a trauma center where he was mostly bedridden and in and out of consciousness for two months. It is now three months since the injury. He has recovered, is out of the hospital, and remarkably doing fairly well. His right eye has permanent vision loss from optic nerve injury. His left eye has reasonable vision, but he does notice a floater often obstructing his vision in that eye. VISUAL ACUITY: Vision OD is 1/200, OS is 20/20. IOP: 15 OU. SLIT LAMP EXAM: There is an afferent pupillary defect in the right eye. There is 1+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.3. The nerve is pale. There is no posterior vitreous separation. The macula and periphery look healthy. OS: Vertical C/D ratio is 0.2. There is an unusually yellow subhyaloid hemorrhage superior to the fovea just barely touching the fovea, and there is also a vitreous floater which does often obscure the macula. The peripheral retina looks fine. OCT SCAN: There is a nerve fiber layer thickness in the right eye of 59 microns and left eye of 111 microns. FLUORESCEIN ANGIOGRAPHY: Photos confirm clinical findings. FA shows hypofluorescence in the area of the yellow spot superior to the fovea, confirming it is preretinal. The right eye has normal flow on the angiogram. IMPRESSION: 1. SUBHYALOID HEMORRHAGE – LEFT EYE 2. VITREOUS HEMORRHAGE – LEFT EYE 3. OPTIC ATROPHY – RIGHT EYE DISCUSSION: I explained to the patient the left eye does have a clearly visually significant subhyaloid hemorrhage and vitreous hemorrhage, however, given that his straight ahead vision is 20/20 and the left eye is now his better eye, I suggested we leave the eye alone. Almost ninety percent of the time, blood in the eye does reabsorb. It is unusual there is this much blood in the eye three months after the injury, but I think probably after the injury, there was much more than this. He will return for check in six weeks. Fortunately blood in the vitreous or preretinal does not damage the retina, so there is no harm in waiting, and if this does not reabsorb over a reasonable amount of time, which may be as much as six months, I think it would be reasonable to consider vitrectomy. He will see you back regularly and return here in six weeks.