Presentation
A 71-year-old white male was seen at the hospital glaucoma clinic for follow-up and reported reduced vision in the LE.
Medical and ocular history
The patient had presented to eye casualty a month previously with raised LE IOP and was diagnosed with LE acute angle closure glaucoma. He had subsequently undergone
bilateral YAG iridotomies.
General health
- Type 2 diabetes since 2007.
- Essential hypertension since 2002.
- High cholesterol.
- Heart disease.
- Stroke in 2020.
- Smoker.
Relevant family history
No family history of eye disease.
Clinical examination
Best-corrected visual acuity: RE 6/9; LE 6/45 (NIPH).
IOP: (Goldmann tonometry at 2.15pm) RE 17 mmHg; LE 28 mmHg.
Visual fields: RE shallow superior nasal step defect; LE widespread loss (superior hemifield > inferior).
Also see table 1.
Medication
Gliclazide, alogliptin, sildenafil, furosemide, clopidogrel, atorvastatin.
Management
Topical medication (g. latanoprost nocte both eyes; g. Cosopt bd LE only) was prescribed to improve IOP control. Given the fundus appearance and the disparity between visual field loss and optic nerve appearance, ocular ischaemic syndrome (OIS) was suspected and fundus fluorescein angiography requested. This showed delayed arterial and venous filling and peripheral ischaemia, confirming the diagnosis of OIS.