Case Presentation

-Dr.Prathibha
 Name - Gayathri.C.R
 Age - 54 yrs/F
 Occupation – House wife
 Place - Bangalore
 Date of examination -07/10/08
 Chief complaints
 blurring of vision –both eyes-left
eye> right eye- 3 months
 Photophobia, redness-left eye-1
month
 History of present illness
 Blurring of vision in BE- 3 months; gradual
progressive,painless LE>RE
 c/o photophobia-redness- LE- 1 month,
discomfort+,watering +,no pain,no discharge
 No h/o foreign body/injury
 No h/o cataract/other ocular surgery
 No h/o using any ocular medication for long duration
 No h/o similar complaints in past in same eye /other
 h/o joint pain+; morning stiffness+; small joints of hand-
MCP/IPJ/KNEE-no involvement of spine/cervical jts
 No h/o fever/malaise/myalgia/weight
loss/diarrhoea/cough/haeomoptysis
 No h/o skin diseases/gastrointestinal
disturbance/pulmonary symptoms
 Past & Personal history
 h/o using oral medication’s for joint
pain – 15 years ; at present using
Tab. Sulphasalazine;Tab- etocoxib;
lubricating e/d be- 6 months
N0 h/0-diabetes/hypertension
 Bowel & bladder –n; attained

menopause-2 yrs; married -2 children

 General physical examination
 PICKLE-ve
 Small joint deformities of hand
+;locked knee+
 Pulse-96/min;BP-
190/110mmhg;weight-70 kg;height-
5.3ft
 Ocular examination
Head posture N

Facial N
symmetry
Ocular N
symmetry
EOM-ductions N N
-versions N
Vision
- 6/18p 6/120
distance 6/12p 6/24
n6 n6
 Lids & N N
adnexa N N
 Lacrimal sac
area
Conjunctiva- N N
forniceal
-bulbar N CCC+
Cornea-size- N N
shape- N N
position- N N
transparency Altered superiorly
-sensation- N
N
Left eye
Left eye
Left eye
Left eye
Right eye
Cornea-lesion- Single superior
perforation of
location-size- 2*3mm horizontally
number- oval in shape at 12
involving the
shape- corneolimbal

surronding area;with 1mm
area adjacent corneal
thinning;few
pigment+;iris
incarcerated in the
perforated wound ;
surrounding
sceral &
conjunctival vessels
are dilated &
tortous/no
tenderness
Rest of the cornea-
Anterior N N
Nin thickness
chamber
Pupil- size- N Irregular peaked
shape-position- superiorly with
prolapse at 12k,
number- reacting
reaction:
direct&
lens Early central Central
consensual
psc+ns-2 psc+ns2

Fundus-direct WNL WNL

ophthalmoscoppy-
indirect
ophthalmoscopy
 Provisional diagnosis
 RE- Early psc+ns2
 LE- Peripheral non infectious corneal
melting with iris prolapse secondary
to collagen vascular disease+central
PSC+NS2
Left eye
Left eye
Left eye
Left eye