Greetings guys,
Happy Sunday to all of us, it is an amazing day and I can sense an amazing week coming right up. This is the week that we leave the month of January and into the month of love, are you excited? Well I am excited, February is going to be great.
But before we get into February though, I hope you are doing very well and staying healthy, I hope the year has been good to you so far and I hope you haven't lost faith in goodness and humanity just yet. Better days are coming, and you will be grateful for them.
As you may already know, whenever I get the opportunity to share anything with you all it is mostly about health or science or the eye, today is no exception just that today I wouldn't be discussing a particular pathology or condition with you but would be talking about a case I oversaw this week.
I am sharing this with you to enlighten you about the eye, the need for care or checkups when things are not well, and for you to have more faith in your doctors that we are on the lookout for the very best for your health. I do hope that you enjoy the read, although it is not much of a happy ending.
Case Report
My patient is a young woman in her early 30s, she presented to the OPD with severe headaches that make it extremely difficult for her to do anything, even a touch of her head or the scalp hurts like crazy, because of this she hasn't bathed in her head for a very long time. Before her visit to the Hospital she has been to three other Hospitals and she has been managed with pain medications due to the severity of the pain.
As it is routine in my hospital any form of headache that analgesics or stronger medication can't clear has to be referred to the eye unit for check before a head CT scan and perhaps a migraine diagnosis after all other tests prove futile. During her routine eye check, I noticed that the optic was very swollen and although her vision seemed not to have been affected yet as she was able to read 20/20 in both eyes, it is only a matter of time before things go south if these inflammatory signs I was seeing persist.
My differentials were papilledema and papillitis, but what was clear was that something was going on within the cranial cavity, either a buildup of pressure or swelling of brain cells which could be caused by anything ranging from a tumor to infection and so there was no way I could do any treatment (which would require the use of steroids which would compromise her immunity and make any infection worse than before).
My next plan was i wanted them to get a head CT scan while I consulted with the GP for us to do a range of tests, luckily they had already done a head CT just before attending the Hospital because the previous facility had also suggested they get it done, a look at the scan had a differential of toxoplasmosis and tuberculoma which needed MRI for a better look. So the GP and I decided to do a tox screen, and test for tuberculosis, syphilis, gonorrhea, and retrovirus.
Before the day ended we had some of the results, Syphilis and Gonorrhea were negative, unfortunately, retro was positive. We had to wait on the other results before breaking the news however it was quite clear to us what was happening now, and we were now feeling certain that she may also probably have a tumor growing up there because her immunity has been compromised for quite a while, as to how long in months or days we couldn't tell exactly.
So we had to break the news to her, the spouse had to be kept out for the time being as it is a dicey situation but before then there was the need for her to have the confirmatory test done and then she had to see a neurologist to also aid in the rest of her treatment. Since this is not my specialty I decided to now hand her over to the GP so they proceed with her and hope that she gets the best care to make things better for her.
Conclusion
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The good thing is that had we not seen the inflammatory signs within the eye it probably would have taken a bit longer for retro to come in as a differential, this is one of the things that makes the eye an amazing diagnostic tool, when you know where to look you could save a life through the eye.
That said, I encourage you to get your eyes checked every now and then, when you have symptoms do not seek relief at the Pharmacy, see the Optometrist, you never know, you could end up saving your own life by doing so. Do now wait it out, love your eyes, get checked. Be safe. Thanks for reading and for your time.
Further Reading
Hohberger B, Mardin CY. OCT Angiography as an Interdisciplinary Diagnostic Tool for Systemic Diseases. Klin Monbl Augenheilkd. 2021 Dec;238(12):1294-1298. English, German. doi: 10.1055/a-1654-0504. Epub 2021 Dec 8. PMID: 34879428..
Luebke J, Boehringer D, Eberwein P, Reinhard T. Corneal K-Values as a Diagnostic Screening Tool for Marfan Syndrome. Cornea. 2017 Jun;36(6):700-703. doi: 10.1097/ICO.0000000000001184. PMID: 28476049..
Faber H, Berens P, Rohrbach JM. Okuläre Veränderungen als Hilfsmittel in der Malariadiagnostik [Ocular changes as a diagnostic tool for malaria]. Ophthalmology. 2022 Jul;119(7):693-698. German. doi: 10.1007/s00347-021-01554-7. Epub 2021 Dec 23. PMID: 34940911.
Hocking MC, Parish-Morris J, Schultz RT, Minturn JE, Brodsky C, Shabason EK, Herrington JD. Diminished social attention in pediatric brain tumor survivors: Using eye tracking technology during naturalistic social perception. Neuropsychology. 2020 Mar;34(3):350-358. doi: 10.1037/neu0000623. Epub 2020 Jan 30. PMID: 31999166; PMCID: PMC7191638..
It gladdens me to see how doctors offer to help the older people with eye care and somehow I haven't gotten the opportunity to be close to one or so for a personal chart.
Back then when i was still in school, I had this very nice grandma (My landlord's mom) and we where more like families (till date, but we don't see that often again) and somehow she do complain not being able to see well which I as of then presumed it was normal for an older person not to see clearly but somehow after I left I got a message her children took her for eye surgery (since she wouldn't stop complaining even when being able to cook by herself and doing things with the eyes) which went successfully and the healing process took a while but this is a bad news though.
She went blind and still blind till date I heard (from her children and traveled back to Nigeria as of when I heard the news to go see her because I was her favorite somehow) I guess it was from her eyes? She is really old so I don't know what else to think except that or do you think there is something they didn't do right for the recovery process? But I believe they must have gotten proscriptions from the doctors right?
She should be in her late 60s or early 70s (I'm not entirely sure) but not veryyy old to some point because she is very beautiful and strong. She talk well like a 20 year old and go out and come back with good health just like a 20 year old.
I have seen In situations where very much more older women are still strong and compare to her, she is just a baby
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