Last additions - Pistol to Temple - Shockwave Retinal Damage 66-year-old woman was seen in the office on 11/24/2010. She had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temporal, toward the lower part of the temporal and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. She did have a post discharge seizure, which was brief and she had low blood pressure at the time. She had bruising of both lids. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. Because of the macular irregularities, she suggested she come here for an evaluation as well.
VISUAL ACUITY: OD light perception, OS 20/400. IOP: OD 11, OS 12.
SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. There is 1+ pallor to the optic nerve. There is posterior vitreous separation. There are pigment epithelial irregularities in the macula.
OS: Vertical C/D ratio is 0.6. There is posterior vitreous separation. There are pigment irregularities in the macula.
OCT SCAN: The OCT scan shows retinal atrophy in both eyes, predominately of the inner retina with full thickness retinal atrophy centrally. The average central thickness in the right eye is 122 microns, the left eye 80 microns.
NERVE FIBER LAYER SCANS: Also show nerve fiber layer atrophy in each eye with the thickness in the right eye being 46 microns and the left eye 77 microns.
Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: Shows the irregular macula hyperfluorescence in each eye from the nongeographic central pigment epithelial atrophy. There is no evidence of any leakage or fluid.
IMPRESSION:
1. ISCHEMIC RETINOPATHY – BOTH EYES
2. CENTRAL RETINAL ARTERY OCCLUSION – BOTH EYES
3. PROBABLE OPHTHALMIC ARTERY OCCLUSION – RIGHT EYE
4. POSSIBLE TRAUMATIC OPTIC NEUROPATHY
DISCUSSION: I explained to the patient that the predominate findings on the testing today is extremely thin retinas, both in the macula and the periphery as well as nerve fiber layer atrophy. This is consistent with either traumatic injury causing traumatic optic neuropathy, but I think probably given the rapidity of the vision loss, this may very well have been from an ischemic event. Either way at this point unfortunately I do not have anything to do for her eyes. I explained to her there is no treatment. We have to either replace or resurrect damaged retina. I suggested however, she return for a check in six months. I asked her to see you back regularly. I gave her recommendations for low vision evaluations as well as counseling that might be helpful to her adapting to her current vision state.
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Pistol to head in attempted suicide - Retinal Atrophy - Shockwave Retinopathy 678 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide - Retinal Atrophy - Shockwave Retinopathy 605 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide - Retinal Atrophy - Shockwave Retinopathy 537 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400460 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400435 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400494 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400511 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400445 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400491 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 13, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400590 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400445 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400434 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400467 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400436 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400416 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400431 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400441 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400450 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400520 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400430 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400558 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400423 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400459 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400557 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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Pistol to head in attempted suicide 3 Months Ago - Retinal Atrophy - Shockwave Retinopathy VA Right Eye - Light Perception - Left Eye - 20/400498 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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598 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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604 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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454 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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549 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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547 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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522 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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493 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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510 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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597 views66-year-old woman had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temple, toward the lower part of the temple and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. OD light perception, OS 20/400. Mar 06, 2011
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707 viewsMar 06, 2011
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66-year-old woman was seen in the office on 11/24/2010. She had a gunshot wound to the head on August 12, 2010, with the entry wound just on the right side, just about below her temporal, toward the lower part of the temporal and the exit wound on the left side just above her cheek, a little behind the eye. Since then she recovered and did not need any surgery. She did have a post discharge seizure, which was brief and she had low blood pressure at the time. She had bruising of both lids. When that all cleared she realized her vision was poor in both eyes. She has seen a neuro-ophthalmologist who thought she had traumatic optic neuropathy. Because of the macular irregularities, she suggested she come here for an evaluation as well.
VISUAL ACUITY: OD light perception, OS 20/400. IOP: OD 11, OS 12.
SLIT EXAMINATION: There is 1+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.6. There is 1+ pallor to the optic nerve. There is posterior vitreous separation. There are pigment epithelial irregularities in the macula.
OS: Vertical C/D ratio is 0.6. There is posterior vitreous separation. There are pigment irregularities in the macula.
OCT SCAN: The OCT scan shows retinal atrophy in both eyes, predominately of the inner retina with full thickness retinal atrophy centrally. The average central thickness in the right eye is 122 microns, the left eye 80 microns.
NERVE FIBER LAYER SCANS: Also show nerve fiber layer atrophy in each eye with the thickness in the right eye being 46 microns and the left eye 77 microns.
Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAM: Shows the irregular macula hyperfluorescence in each eye from the nongeographic central pigment epithelial atrophy. There is no evidence of any leakage or fluid.
IMPRESSION:
1. ISCHEMIC RETINOPATHY – BOTH EYES
2. CENTRAL RETINAL ARTERY OCCLUSION – BOTH EYES
3. PROBABLE OPHTHALMIC ARTERY OCCLUSION – RIGHT EYE
4. POSSIBLE TRAUMATIC OPTIC NEUROPATHY
DISCUSSION: I explained to the patient that the predominate findings on the testing today is extremely thin retinas, both in the macula and the periphery as well as nerve fiber layer atrophy. This is consistent with either traumatic injury causing traumatic optic neuropathy, but I think probably given the rapidity of the vision loss, this may very well have been from an ischemic event. Either way at this point unfortunately I do not have anything to do for her eyes. I explained to her there is no treatment. We have to either replace or resurrect damaged retina. I suggested however, she return for a check in six months. I asked her to see you back regularly. I gave her recommendations for low vision evaluations as well as counseling that might be helpful to her adapting to her current vision state.
