Chapter 14

### The eyes have it: five short case histories

The following case histories of interesting eye problems have presented to the author in the past 12 months.

#### CASE 1: IAN M, AGED 30, MOTOR MECHANIC

Ian’s wife rang me at 2 am with a suggestion of panic in her voice. Ian was extremely distressed with agonising pain and ‘burning’ of both eyes: he felt he was going blind. Mrs M could think of no reason for his eyes to be affected this way. He had been perfectly fit and well when he went to bed. A distressed Ian groped his way through the surgery door. On examination, his eyes were very red but there was no discharge.

#### CASE 2: JIM W, AGED 56, FISHERMAN

Jim presented because of deterioration of vision in his right eye during the previous six weeks. The sight in his left eye was good. The right eye felt hard and the pupil was dilated. Visual acuity was 6/60R and 6/9L (Snellen chart). Intra-ocular tension 28 mm Hg (Schiotztonometer)—right eye. Ophthalmoscopy revealed a vitreous haemorrhage and an apparent retinal detachment. The clinical picture was very confusing and so I arranged an urgent appointment for him with an ophthalmologist.

#### CASE 3: BRUCE D, AGED 42, DENTIST

Bruce’s left eye had been painful for two days. There were no other symptoms and his vision was satisfactory. He had three small superficial ulcers on the lid margins and mild conjunctival hyperaemia but no other abnormal findings. He returned the next day saying his eye was worse and his vision was blurred now, despite using the prescribed chloramphenicol ointment.

#### CASE 4: CRAIG F, AGED 10, RASCAL

Craig presented with an intolerance of sunlight, especially in his right eye and his parents had noted the pupil was larger than the left. He was otherwise well and there was no history of trauma. The right eye revealed a fixed dilated pupil: the other was normal.

#### CASE 5: WENDY M, AGED 10 WEEKS, BABY

Following grandmother’s prompting, Wendy was brought along by her mother because her left eye was ‘different’: the pupil was enlarged and was a different, unusual colour. Mrs M had noted also that Wendy had not smiled yet her sister, by that age, had. On examination the findings were confirmed with the left pupil showing a yellow light reflex. She was referred to an ophthalmologist.

###### THE DIAGNOSES

1. Ian M had ‘flash burns’ caused by watching a builder doing some arc welding that day. The pain was due to an oedematous corneal epithelium and blepharospasm caused by exposure of the unprotected eye to the intense ultraviolet light from the oxyacetyelene torch.

Remember this possibility for any patient who rings during the night ...

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