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Here you’ll find interesting cases of eye conditions along with news and developments in the ophthalmology world.

Cases are presented as an initial image with history and examination. Health practitioners are encouraged to deduce the condition, before further investigations, diagnosis and management are presented.

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Right fundus photograph showing a haemorrhage at the right macula.

Case 18

Figure 1. Right fundus photograph showing haemorrhages temporal to the optic disc.

Author: Dov Hersh     Editor: Adrian Fung

A 10-year-old boy was referred with blurred left vision following blunt ocular trauma.

Case history

A 10-year-old boy presented with blurred left vision after being hit in the eye with a cricket bat. The patient was emmetropic. The patient’s medical, surgical, and family histories were unremarkable.

Visual acuities were 6/5 in the right eye (OD) and 6/120 (no improvement with pinhole) in the left eye (OS). Intraocular pressures were 8mmHg in each eye. The left pupil was mildly dilated. There was no contralateral (“reverse”) relative afferent pupil defect (i.e. no further constriction of the right pupil when light was shone in the right eye after the left), suggesting normal left optic nerve function.

External examination of the left eye revealed periorbital oedema and ecchymosis. Extraocular movements were within normal limits and there was no enophthalmos. Orbital fracture was excluded clinically. In the left eye there was a small iris rupture and a few red blood cells in the anterior chamber but no macro-hyphaema nor angle recession on gonioscopy.

Fundus examination revealed an abnormal foveal reflex and haemorrhages temporal to the optic disc (Figure 1). No peripheral retinal tear or dialysis was noted.

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