Clinical

Case
Histology

Balingbing, Jonas Z.
 EYE CASE
A case of a 40year old hypertensive female with complaints of pain and redness with
marked dimness of vision, involving the left eye, for 3 consecutive days. Patients
noted symptoms of headache and nausea. On PE, pertinent findings are ciliary
congestion and shallow anterior chamber on the left eye, with IOP of 69mmHg.

Question: Identify the eye chamber affected in the case, Discuss briefly the eye
drainage system.
 Ocular hypertension
Ø Ocular hypertension is a condition where the
pressure in your eyes, or your IOP, is too high.

Ø Continually high pressure within the eye can

eventually damage the optic nerve and lead to
glaucoma or permanent vision loss.

Ø Normal eye pressure ranges from 12-22 mm Hg,

and eye pressure of greater than 22 mm Hg is
considered higher than normal.
 Eye chamber affected in the case
Ø The clear fluid inside the eye is produced by
the ciliary body, which is a small, circular structure
found behind the iris or colored portion of the eye.

Ø This fluid, known as the aqueous humor, flows behind

the iris and through the pupil or central opening in
the middle of the iris.

Ø The aqueous humor then fills the anterior chamber, a

space between the back of the clear cornea and the
front of the iris.
Source: https://cdn.allaboutvision.com/images/glaucoma-
Ø The aqueous exits the eye through a structure known 330x220@2x.jpg

as the drainage angle, which is the angle formed

inside the anterior chamber between the iris and the
peripheral cornea.

Ø The aqueous filters through this angle and through

the sclera or white part of the eye and then joins with
the network of veins outside the eye.
 EAR CASE
Case 1: A case of a 49year old non-hypertensive female who
presents with chronic history of recurrent dizziness with
occasional nausea. Dizziness spells are described as episodic,
brief, and related to head position changes. Neurologic exams
are normal.

Case 2: A case of 50year old non-hypertensive male with

episodes of dizziness, occasional hearing loss, and tinnitus or
ringing sensation. CT imaging is normal.

Question: Identify the ear region affected in the two cases.

Explain the difference in the disease presentation of the two
cases, in reference to the ear anatomy and functions
 Case 1 Peripheral vertigo
Benign paroxysmal positional vertigo
(BPPV)
Ø Is a disease of the vestibular system of your
inner ear. When you change your head position,
it causes vertigo. Vertigo is a feeling that the
room is spinning around you.
Ø They include the utricle, saccule, and 3
semicircular canals. When your head moves,
these small organs send this information to the
brain.
Ø The utricle contains small calcium crystals.
These help you to sense motion. Sometimes
these crystals detach from the utricle and land
in one of the semicircular canals. Then the
canals may send the wrong signals to the brain,
especially when the crystals move. This
confuses the brain and leads to BPPV
symptoms.
Ø Anything that dislodges the crystals from the
utricle can cause BPPV. Having a past head
injury is a major cause.
Case 2
Meniere’s disease
Ø Meniere’s disease is a disorder that affects the
inner ear. The inner ear is responsible for hearing
and balance.
Ø The condition causes vertigo, the sensation of
spinning. It also leads to hearing problems and a
ringing sound in the ear. Meniere’s disease usually
affects only one ear.
Ø Sudden vertigo that can last for up to 24 hours.
Ø The cause of Meniere's disease is unknown.
Symptoms of Meniere's disease appear to be the
result of an abnormal amount of fluid (endolymph)
in the inner ear.
Ø Factors that affect the fluid, which might
contribute to Meniere's disease, include:
• Improper fluid drainage
• Abnormal immune response
• Viral infection
• Genetic predisposition
 Reference
● https://www.glaucoma.org/gleams/high-eye-pressure-and-
glaucoma.php

● https://www.allaboutvision.com/conditions/glaucoma-2-
cause.htm

● https://www.vsp.com/eyewear-wellness/eye-health/the-
causes-of-hypertension

● https://www.healthline.com/health/peripheral-vertigo#types

● https://www.cedars-sinai.org/health-library/diseases-and-
conditions/b/benign-paroxysmal-positional-vertigo.html

● https://www.mayoclinic.org/diseases-conditions/menieres-
disease/symptoms-causes/syc-20374910
THANK YOU!