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First Author: V.Vohra INDIA
Co Author(s): M. Gupta P. Malik
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To report a case of optic neuritis with secondary retinal venous stasis in a case of abdominal tuberculosis
Department of Ophthalmology, Dr.RML Hospital & PGIMER, New Delhi, India
Case report of a 18 year old boy presenting with rapid, painless progressive loss of vision in the left eye since 10 days .Systemic complaints included evening rise of temperature, abdominal discomfort and loss of appetite for 1 month . There was no past medical history or history suggestive of any neurological deficit. He was a non?smoker with no significant family history of illness.
Patient had a Snellens acuity of 6/6 (OD) and 3/60 (OS) .Using Ishihara pseudo isochromatic charts, defective red green colour vision was found (score = 10). Pupillary examination revealed left relative afferent pupillary defect. Fundoscopy of the left eye revealed a hyperaemic oedematous disc with dilated and tortuous peripapillary vessels (A:V 2:4). Macular area showed retinal folds. On indirect ophthalmoscopy, posterior pole showed venous sheathing seen in all 4 quadrants. Flame shaped haemorrhages were seen surrounding these vessels in the superotemporal quadrant. Retinal periphery was spared. The right eye fundus was unremarkable. Fluorescein angiography showed peripapillary blocked fluorescence and increasing hyperfluorescence around veins, extending from disc to mid periphery of left eye.Patient had a single 3 x 3 cm palpable lymph node in right supraclavicular area. No neurological deficit or other systemic anomalies were detected. Abdominal ultrasonography revealed multiple enlarged lymph nodes in retrocaval region of right renal hilum and in the mesentery. Fine needle aspiration smears from right cervical swelling showed necrosis with degenerated acute and chronic inflammatory cells and Z N stain positive for acid fast bacilli.
Diagnosis of left eye tubercular optic neuritis with retinal venous stasis with abdominal tuberculosis was made. Patient was started on anti-tubercular therapy under steroid cover. Improvement in acuity and clinical picture was seen as soon as five days.