Sheet

Personal History : Male patient named (......) aged 65 years old from (......) work as a farmer Complain : gradual diminution of vision Present History : gradual painless progressive diminution of vision in left eye since 2 monthes Past history : there is past-history of corneal ulcer in right eye with cataract extraction and IOL implantation since 6 years . no past history of systemic diseases ( diabetes and hyper-tesion ) past history of medications for cancer 2,5 mg Family History : no similar condition among his family Examination : Item

Rt eye

Lt eye

External Apperance Dermatochlasis Mild ptosis Corneal opacity

Dermatochalasis Lateral angular lid mass exotropia 15 degree

Visual Acuity

Uncorrected 1/60

Uncorrected Hand Movement

Ocular Motility

Normal in 6 cardinal directions Uniocular and in 9 directions binuclear

Eye lid

Dermatochalasis Mild ptosis Normal function and margin

Dermatochalasis Mild ptosis Normal function and margin

Lacrimal Apparatus Lacrimal gland not seen not felt in both eyes Conjunctiva

T3

Nasal pinguecula Palprebral conjunctiva T3

Sclera

White and opaque

White and opaaque

Cornea

Paracentral non-adherent leucoma Paracentral Nebula Upper limbal scar Cornea is sensitive

Clear Sensitive

Anterior Chamber Deep anterior chamber with Shallow anterior chamber with no abnormal content Pupil

Irregular non reactive to light directly or consensual light mydratics

dilated regular rounded non reactive to light directly or consensual under

Iris

There is iris laceration with patches or iris atrophy and iridectomy

normal colour and pattern

Tn digitally

Tn digitally

Tension Visual Field

Good Confrontaion Test

Good Projection of light

Diagnosis Right Eye - Dermatochalasis and mild ptosis and paracentral leucoma adherent and nebula with pseudophakia Left Eye - Dermatochalasis and mild ptosis and specious cyst and exotropia of 15 degree and intumescnet cataract no abnormal contents Doctor Notes and discussion : -people dealing with Laser, Infrared o radiation is more susciptable for cataract -farmer vision of 2/60 , no need for more and no need for surgery , this is enough -compalin , 5 items : Gradual ( not sudden or rapid ) Painless ( may be painful when ? ) Progressive ( congenital type is stationary ) Left eye 2 monthes - other complain of cataract ; night or day blindness or diplopia - EXCEPT : hypermature cataract there is no Diplopia ( totally Opaque ) - Drug-induced cataract : Posterior sub-capsular cataract >> total ( Cortison ) Anterior capsular and sub-capsular cataract ( Pilocarpin ) - which is more complicated , systemic or local cortison ?? Local Cortison >> Glaucoma more than cataract Systemic Cortison >> Cataract more than glaucoma - when diplopia occur in cataract ? not totally opaque lens is subluxated leaving an area opposite the pupil transimiting the light -when can i say this lens is "Subluxated or Dislocated" ? more than 30 of zenules are affected >> Dislocation less than 30 of zenules are affected >> Subluxation

-what is normal External Apperance ? Corneal Reflex Corneal Lustre Upper eye lid : cover upper 1/6 of cornea Lower eye lid : touch the cornea Globe a line between the middle of upper bony margin and the middle of lower bony margin that pass touching the cornea Orthophoria -Hand movement VA present in mature cataract but what if present in immature case? Post Segment disease -IOL but 1/60 ?? wrong calculation of IOL Subluxation Opacified posterior capsule ( common ) we use laser to open a hole in it cystoid macular oedema