History
A 59-year-old white male presented with a chief complaint of glare and diplopia O.S. He said that he first noticed these symptoms some six or seven months earlier, and that they had slowly worsened. He also noticed that the vision in his left eye was mildly decreased and did not improve with time. The patient was corrected with spectacles and did not wear contact lenses.
The patient said he saw several local ophthalmologists and optometrists, who diagnosed bacterial corneal infection/ulcer and prescribed various topical antibiotics. Because his occupation as a commercial truck driver required good visual acuity and these therapies did not help, he decided to obtain yet another opinion.
At this visit he reported minimal discomfort from the glare and photophobia but was remarkably in no pain. He had no pertinent ocular or systemic history. He was using vidarabine ointment bid O.S. at the time of this consult.
Diagnostic Data
Best-aided visual acuity was 20/20 O.D. and 20/70 O.S. at distance and near. External examination was normal, and there was no evidence of an afferent pupillary defect. Refraction yielded mild compound myopic astigmatism correctable to 20/20 O.D. and 20/40 O.S. at distance and near.
Biomicrosopy was normal O.D., but revealed a
kidney bean-shaped, excavated hazy lesion O.S. The lesion was in the superior temporal quadrant of the cornea. A mild anterior chamber reaction was present O.S. Sodium fluorescein staining was present and localized only to the defect O.S. Corneal sensitivity, as compared to the right eye, was reduced.
Slit-lamp exam revealed a lesion in the superior temporal quadrant of the cornea.
IOP measured 12mm Hg O.D. and 13mm Hg O.S. The dilated fundus examination uncovered large cup-disc ratios, but the posterior segment structures otherwise appeared healthy.
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Thanks to Dan Johnston, O.D., for contributing this case.
