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Primary Open Angle Glaucoma

Case Presentation

Supervisor: Brig. Mazhar ishaq

CASE

Patient Profile
Name
Age Gender

Residence
Occupation Presented on

XYZ 60 years Female Rawalpindi House wife 20th November,2012

Presenting Complaints
Gradual deterioration of vision for last 8 years in both eyes

History of Presenting Complaints


It is a known case of POAG Painless, gradual blurring of vision

Redness, photophobia, discharge, itching, irritation, distortion of images

Past Ocular History


Presbyopic glasses for 2 years Known case of POAG and taking anti-glaucoma drugs for last 8 years No h/o of cataract, strabismus, eye infections or other eye medications

Past Medical History


Diabetes 1 Month Hypertension Asthma Peripheral Vascular Disease NAD IHD Heart failure/Block Hepatitis

Drug History
Tablet Metformin and Glibenclamide BD 0.5% levobunolol 1 drop BD No known drug allergies

Personal History
House-wife, no h/o substance abuse

Family History
No glaucoma or ocular or systemic disease

Examination

General Physical Examination


Vital signs
Pulse Temperature Blood pressure Respiratory rate

68 beats/min 98.6F 120/70 mmHg 17 breaths/min

Pallor Jaundice Edema Cyanosis Thyroid Lymph nodes JVP

NAD

Not Enlarged Not Palpable Not Raised

Systemic Examination

Cardiovascular system Genitourinary system Respiratory system Central nervous system

NAD

Ocular Examination
Right eye
6/12 6/6 partial
(+2.50DS/-1.5DCx90)

Left eye
Visual acuity best corrected visual acuity Pin hole Near vision Colour vision Visual fields (confrontation method) Extra ocular movements 6/18 6/6 partial
(+3DS/-1.5DCx90)

6/6 partial N12 normal normal

6/6 partial N12 normal normal

normal

normal

Right eye
normal normal normal Deep/formed Round, regular, reactive Adnexa Conjunctiva Cornea Anterior Chamber Pupil

Left eye
normal normal normal Deep/formed Round, regular, reactive

clear

Lens

clear

Right eye
15 IOP

Left eye
16

normal normal

Vitreous Retina

normal normal

Ocular Examination
Right Eye Left Eye

Gonioscopy
Right eye Left eye

11 1
1v 11 1 111

111 111 1v

Visual Field

Optical Coherence Tomography

Investigations
Pachymetry (micrometre)

Right eye

Left eye

551

554

Provisional Diagnosis
Primary Open Angle Glaucoma

Management
Primary aim is to lower and maintain intra-ocular pressure (target pressure) Monitoring of optic nerve and visual fields

Medical Therapy
0.5% levobunolol 1 drop BD

Follow up
Counseling:
Regular and meticulous use of medications Screening of family members

Monthly:
IOP measurement Visual acuity C/D ratio

Annually
Gonioscopy Visual field assessment OCT (optic nerve fibre layer thickness)

THANKS