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Grand Rounds Case #89 and Dr. Hom's Response |
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OD Disc Photograph
History
- CC: 81 year old HF presents for base
line retinal examination and for the suspicion of glaucoma
- Most recent HbA1c 7.0%;
Hypertension; Hyperlipidemia; Hypothyroidism; Microalbuminuria
- KDA - Lisinopril
- Meds - (1) Glipizide, 10mg qAM and
5mg qPM (2) Hydorchlorothiazide, 25mg, 1/2 tablet, daily (3)
Atenolol, 50mg, daily (4) Levothyroxine, 100 mcg, daily (5)
Ibuprofen, 400mg, q 4-6 hrs, PRN
- Admits to stopping glaucoma
medications AMA (against medical advice) because she thought she
was "cured". Has not attempted to schedule an appt.
- Oriented x 3
Physical examination
- Entry sc OD 20/50
OS 20/CF 6 ft
- Intraocular pressures (TA, 09:22hrs)
were OD 26 mm Hg and
OS 28 mm Hg.
- Dilated fundus examination revealed
a large chorioretinal scar with a etiology of most likely
toxoplasmosis.
Question:
Just from the fundus photo alone, what do
you think of this disc?
Dr Hom's Response
Just from the fundus photo alone, there is
an apparent thinning of the superior neural retinal rim. Of course
this possible defect of the disk must be correlated to any other
functional or structural test or imaging.
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