The College of Optometrists

she said her right eye had suddenly gone blurry on awaking a month ago. She thought it was a cataract. She is 62 and in good health - although I thought that her vessels showed signs of hypertension and I advised her to get it checked. i automatically dilated expecting retinal, vascular or else. But it was impossible to see her retina. I found a mild cataract - but her corneae was steamy and very hazy, the endothelium looked patchy and interestingly her epithelium stained. Mainly central punctate stains coalescing in the corneal apex and fading towards the limbus. There were many granular specs within the fluorecene. Her left eye was similar - but not so affected. Vision R6/36 L 6/21

best. There was no flare or sign of intra ocular activity. Could it have been something in her eye like hair spray? She was under no distress at all and her tear film was normal. i could get no puff on tonometry as her corneae was so dull. i sent her directly to hes.

??fuchs. would expect more symptoms but otherwise sounds a bit like it.

Fuchs is the first thought that ran through my head....especially based on her age and gender. Plus interestingly this does give variable sx's. The other thing here is that I would have thought its worse in the morning and sx's ease towards the afternoon. Do you recall seeing any buckling of the stroma or opacification???

Sounds like overnight corneal decompensation with epithelial oedema, probably Fuch's or bilaterally high IOPs - unlikely (what was the A/C depth like?). It's unlikely this was sudden, I bet her vision had been down for a while but she'd only just noticed?

Floopy lid syndrome?

Was she overweight with very flacid lids?

Did she recentally have a fan installed over her bed?

I am a bit concerned that she was not in any distress. I would expect that type of staining to be at least a bit uncomfortable. I am now thinking some sort of a viral component?

This has been going on for a month? What was she doing in this time? Isn't it weird that it took this long to get checked? Maybe a physciatric (sp?)component to this?

meyed - not sure where you work but I don't think it's uncommon at all for patients with reduced VA (even fairly sudden onset) not to seek advice, as they assume its "just a cataract" and they "know" that a cataract has to be ripe before they can have surgery.

I've seen vein occlusions, ARMD, and advanced glaucoma present in this way, where the patient was aware of reduced VA, but assumed it was a cataract and didn't seek advice.

I think to suggest psychiatric prob on this basis is a bit extreme.

Lisa

You may be right Lisa, on the other hand, perhaps psychiatric problems are more common than we thought.

I am back! Thanks for the stuff. She isnot overweight. Her angles were open - I could see past the corneal oedema/steaming just a bit in the left eye and viewed the retinal veins and arteries - looked abit narrowed to me. I will phone her monday and find out what the HES think. She was a sober as a judge and not in slightest upstairs. I wonder is the visual problem was gradual and she didnot notice until it got dire. After I told her - she opted to goto eye casualty (so she was worried - but I have a way of worrying people) - I will let you know - palfio

thanks for all the input

:-))

spoke to her today -

the hospital said ' yr corneas are wearing out and there is nothing we can do'.

i suppose that makes it fuchs dystrophy - thank you for all yr help