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Age/Sex/Race
A Caucasian female in her 40s
Chief Complaint
“I have had a constant blur in right eye for past 6 years. I have seen several doctors over the years but they can’t seem to figure it out.”
Medical History
None
Ocular History
Glasses for distance
Medications
Vitamin B, Ocuvite, Ibuprofen, Aspirin
Allergic to Penicillin
Family History
Mother – Cancer
Father – Diabetes, Cataracts
Social History
Social drinker
Diagnosis and initial plan of action
I didn’t get to see the patient so I didn’t have to worry about this. I work at a private practice on Saturdays, where one of the doctors had seen this patient.
Applicable Testing & Results of Testing
Distance visual acuity (uncorrected) – forgot to obtain this information from the doctor
Cover Test: Ortho
Confrontation fields: FTFC OU
Extraocular muscles: Full OU
Pupils: PERRLA, (-) APD OS; + APD OD
Manifest Refraction:
OD: -1.25 – 0.75 X 122 20/50
OS: 0.00 – 0.50 X 075 20/20
Add +2.25
Slit lamp examinationL
Lids/lashes, conjunctiva, cornea – clear OU
Anterior chamber – no cells or flare
Angles – open OD, unable to view OS
IOP – 12 mm Hg OU
Dilated fundus exam
Lens – Clear OU
C/D – 0.3/0.3 OU
ONH – complete pallor OD (see below picture), normal OD
Posterior pole / macula / periphery – normal OU
Visual Field – see pictures below
OD – severe depression of overall visual field
OS – localized visual field defect
Assessment and Plan
The patient had primary optic nerve atrophy with an unknown etiology. Since the doctor didn’t know what had caused it or what was causing it, he referred the patient to neuro-ophthalmologist for further investigation. After running few tests such as MRI, the patient was diagnosed with sphenoid meningioma. She had a surgery to remove the tumor, which gave her vision back (20/20). It is unfortunate that patient had blurry vision for so long and no one was able to help her. She had even gone to a major hospital, where they had run the visual field but they missed it. The case just reminds us that if we can’t figure something out for a patient, we have to find answers or refer the patient to appropriate person to help them.
Little bit about sphenoid meningioma from The Massachusetts Eye & Ear Infirmary:
- Benign, slow-growing tumor
- Most commonly occurs in females with mediate age of 38 years old
- Symptoms (depending on location) – proptosis, globe displacement, diplopia, decreased visual acuity and optic neuropathy
- Treatment
- Radiation is first line of therapy
- Excision of the tumor if no useful vision remains
