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Red eyes, reduced vision, and vomiting
  1. N Dhingra,
  2. M T Watts
  1. Department of Ophthalmology, Arrowe Park Hospital, Upton, Wirral, UK
  1. Correspondence to:
 Mr Dhingra; 
 ndhingra99{at}yahoo.com

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Answers on p 546.

A 67 year old woman was referred by her general practitioner to our accident and emergency department with a two day history of nausea, vomiting, and blurred vision in both eyes. Her drug history included that of taking atenolol and paravastatin. Five months before this referral, she had suffered a stroke and computed tomography then had revealed parietal lobe haemorrhage. She was examined by the casualty doctor and was subsequently admitted on the medical ward for management of her systemic symptoms. The systemic symptoms improved on antiemetics but she continued to complain of poor vision from both her eyes. Subsequently she was referred to the eye department.

Six months before this referral to the eye clinic, a dilated fundus examination had revealed a macroaneurysm in the right eye not involving the fovea. The visual acuity recorded on that occasion was 6/6 in both eyes.

Ocular examination revealed visual acuities of hand movements in both eyes. The anterior segment photographs of both eyes are shown in figs 1 and 2. Intraocular pressure was recorded to be 14 mm Hg in each eye.

Figure 1

Right eye showing corneal oedema and iris atrophy.

Figure 2

Left eye showing corneal oedema and iris atrophy (more marked in this eye).

QUESTIONS

  1. Describe the anterior segment photographs.

  2. What is the diagnosis?

  3. How would you manage this patient?

  4. What is the cause?

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