Oman Journal of Ophthalmology

CLINICAL QUIZ
Year
: 2018  |  Volume : 11  |  Issue : 2  |  Page : 187-

Sudden paracentral scotoma in a middle-aged male


Reem Al Motaem, Mohammed Al Abri 
 Finland Eye Center, Muscat, Oman

Correspondence Address:
Reem Al Motaem
Finland Eye Center, Muscat
Oman




How to cite this article:
Al Motaem R, Al Abri M. Sudden paracentral scotoma in a middle-aged male.Oman J Ophthalmol 2018;11:187-187


How to cite this URL:
Al Motaem R, Al Abri M. Sudden paracentral scotoma in a middle-aged male. Oman J Ophthalmol [serial online] 2018 [cited 2019 Sep 17 ];11:187-187
Available from: http://www.ojoonline.org/text.asp?2018/11/2/187/233301


Full Text



A 40-year-old male presented with a 1-day history of the right eye paracentral scotoma.

Medical history revealed diabetes mellitus (DM) for 10 years and hyperlipidemia, on medications.

Best-corrected visual acuity was 20/20 (with − 0.75–0.75 × 90) OD and 20/20 (with − 0.75–0.75 × 80) OS.

Intraocular pressure (IOP) (mmHg) was 21 OD and 22 OS. Anterior segment examination was unremarkable OU.

Dilated funds examination revealed abnormal findings OD [Figure l]a along with optical coherence tomography (OCT) macula [Figure 1]b, otherwise mild nonproliferative diabetic retinopathy changes OU. His systemic review was unremarkable.{Figure 1}

 Questions



What are the abnormal retinal findings as shown in [Figure 1]a,[Figure 1]b,[Figure 1]c?What is the differential diagnosis?What is most likely the diagnosis based on history, clinical examination, and investigations?What is the proper management in such case?

For answers please see page 192.

 View Answer

 Answers



Abnormal retinal findings

Fundus photograph shows cloudy white edematous retina superonasal to the foveaOCT macula shows thickening of the retinal nerve fiber layer superonasal to the fovea corresponding to the changes in fundus photographFluorescein angiography shows hypofluroscence of involved segment, multiple microaneurysms, with no obvious emboli.

Differential diagnosis:

Branch retinal artery occlusion (BRAO)Cilioretinal artery occlusion.Retinal artery macroaneurysm

Most likely diagnosis: BRAO.

The management:

Lower IOP: Topical and systemic IOP-lowering medicationsOcular massageControl high blood pressure (BP) and other relevant risk factors (DM, hyperlipidemia etc.)

In this patient, BP was found to be 190/100 mmHg for which was referred to an internist for the further management of hypertension.{Figure 2}

The clinical diagnosis in this young man revealed right eye BRAO, and with aforementioned management measures, the patient showed improvement in scotoma and resolution of the white edematous area as shown below [Figure 2]a and [Figure 2]b.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.