Case presenattion on cataractttttttttttt

Case presentation on cataract

1. CASE PRESENTATION  AMIT KUMAR SHAH MBBS, 21 ST BATCH

2. PATIENT’S PARTICULARS Name :- BUDDHI KUMARI LAMA Age/Sex :- 68 years/ female. Address :- Jorpati , Religion:- Buddhist Presented to Ophthalmology OPD with chief complaints of: BLURRING OF VISION FOR 1 year.

3. HISTORY OF PRESENTING ILLNESS: According to the patient, she was in her usual state of health 1 year back when she started to develop blurring of vision in both eyes which was gradual in onset, painless and progressive in nature and was associated with itching, watering, headache and photophobia. The patient also complains of some hazy spots in front of eyes which appeared on and off and moved with eye movement. There is no h/o redness, colored halo, flashes of light, double vision, burning or foreign body sensation.

4. PAST HISTORY There is no history of similar complain in the past. No history of ocular trauma or ocular surgery. History of use of glasses for 20 years . History of Hypertension and Diabetes Mellitus for past 14 years Under medication.

5. PERSONAL HISTORY She consumes veg diet. She is non-smoker and non-alcoholic. No recent change in bowel or bladder habit. The appetite and sleep cycle is usual.

6. FAMILY HISTORY There is no history of similar complains in the family. No history of cataract/glaucoma in the family.

7. SOCIO-ECONOMIC HISTORY There are 4 members in the family, live in the concrete house of 3 rooms with separate kitchen, rooms are well-lighted and well-ventilated, drinks jar water and uses LPG gas for cooking.

8. DRUG AND ALLERGY HISTORY: No known allergy known till date. She is under : 1.TAB DIAPRIDE M2 Forte BD 2.TAB LINTOR 5 MG PO OD 3.TAB AMREST 5 MG PO OD

9. ON EXAMINATION General Examination: She is conscious, cooperative and well-oriented to time, place and person. Vitals: Pulse : 94 bpm, regular, normal in rate and rhythm with no RR or RF delay and all peripheral pulses palpable. BP: 140/80 mm Hg on left arm, in sitting position.

10. Cardinals: There is no pallor, icterus, palpable lymph nodes, clubbing, cyanosis, edema and no signs of dehydration.

11. OCCULAR EXAMINATION FEATURES RIGHT EYE LEFT EYE Visual acuity 6/36(unaided) 6/24 (glasses) 6/36(unaided) 6/18(glasses) HCRT Corneal light reflex central Corneal light reflex central Extra ocular movement Full and free in all the direction of gaze Non tender Full and free in all the direction of gaze Non tender

12. Head posture : Normal, straight, looking forward and chin not elevated. Facial symmetry : Face is symmetrical with wrinkling over her forehead

13. Features Right eye Left eye Eyebrows Level of two eyebrows are at the same level Complete cilia present Eyelid a)Lower eyelid touches the limbus in both eyes. b)Upper eyelid covers 1/6th of the cornea in both eyes. c)Lid margin is normal and there is no discoloration of cilia, trichiasis a)Lower eyelid touches the limbus in both eyes. b)Upper eyelid covers 1/6th of the cornea in both eyes. c)Lid margin is normal and there is no discoloration of cilia, trichiasis Lacrimal apparatus Puncta and lacrimal sac is normal. There is no swelling,redness , fistula in area overlying lacrimal sac in both eyes. Puncta and lacrimal sac is normal. There is no swelling,redness , fistula in area overlying lacrimal sac in both eyes.

14. Features Right eye Left eye Conjunctiva a)Bulbar-No discoloration, congestion, redness, chemosis , foreign body and pterygium . b)Palpebral-No congestion, papillae, follicles or foreign body. c) Fornices -No congestion, discoloration. a)Bulbar-No discoloration, congestion, redness, chemosis , foreign body and pterygium . b)Palpebral-No congestion, papillae, follicles or foreign body. c) Fornices -No congestion, discoloration. Sclera No discoloration and inflammatory changes No discoloration and inflammatory changes Cornea Normal in shape and size . Surface is smooth and transparent. Arcus senilis -Present Normal in shape and size. Surface is smooth and transparent. Arcus senilis -Present Anterior chamber Normal depth contains transparent watery fluid. Normal depth contains transparent watery fluid.

15. Features Right eye Left eye Iris Dark brown in color, no synechiae, nodule, mole or cyst. Dark brown in color, no synechiae, nodule, mole or cyst. Pupil Centrally placed, normal in size, greyish white in color and reactive. RAPD(-) Centrally placed, normal in size, greyish white in color and reactive. RAPD(-) lens Centrally placed with grayish white opacification . Iris shadow present. Centrally placed with grayish white opacification . Iris shadow present.

16. PROVISIONAL DIAGNOSIS: BE Immature senile cataract DIFFERENTIAL DIAGNOSIS: u HYPERTENSIVE RETINOPATHY u AGE RELATED MACULAR DEGENERATION

17. MANAGEMENT PLAN RE CATARACT SURGERY. Since her Blood Sugar was 316 mg/dl and 360 mg/dl even with oral hypoglycemic drugs, she was advised HbA1c and urine for ketones by General medicine to review her for starting Insulin. Surgery is postponed till her blood glucose level comes to normal.

18. Definitive management for senile cataract is lens extraction. Types: 1) Intracapsular cataract extraction(ICCE ) 2) Extracapsular cataract extraction(ECCE): a)Conventional extracapsular cataract extraction b)Small-incision cataract surgery(SICS) c) Lensectomy d)Phacoemulsification

19. THANK YOU