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Abstract: An 85-year-old female patient with sudden onset of vision loss in the left eye, blurred vision with ocular foreign body sensation, grinding pain and other discomfort six months ago, and sudden onset of left eye distension and discomfort with headache one month ago, came to our hospital for examination and clear diagnosis of glaucoma and left eye blindness. She was given mannitol injection, eszopiclone tablets, timolol maleate eye drops, and brinzolamide eye drops for treatment.
Basic information】Female, 85 years old
Type of disease】Glaucoma (neovascular glaucoma)
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】January 2022
Treatment plan】Intravenous injection (mannitol injection) + oral medication (eszopiclone tablets) + topical medication (timolol maleate eye drops, brinzolamide eye drops)
[Treatment period] Hospitalization for 1 week, review after 3 days, long-term follow-up
Treatment effect] Symptoms improved, stable condition
I. Initial consultation
The patient was 85 years old, and about half a year ago, she suddenly developed decreased visual acuity in her left eye, blurred vision, foreign body sensation and grinding pain, no eye redness, eye pain, tearing, eye distention, nausea, vomiting, rainbow vision, no visual distortion, visual double vision and other discomforts, which could not be relieved after rest. 1 month ago, she suddenly developed distension and discomfort in her left eye, accompanied by headache, and came to our hospital for further treatment. 4.6, left eye perception (-); intraocular pressure: 12 mmhg in the right eye, 46 mmhg in the left eye, left eye pupil was not round, about 7 mm in diameter, loss of light reflex, uneven clouding of lens cortex in both eyes, vitreous clouding; fundus: arteriovenous cross-compression of the optic disc in the right eye (+), unclear reflection of the macular center, pale optic disc in the left eye, arteriovenous cross-compression (+), scattered retinal spots The initial diagnosis was glaucoma (neovascular glaucoma), and the patient was admitted to hospital for treatment.
Treatment history
After the patient was admitted to the hospital, he cooperated actively to improve the ocular and systemic ancillary examinations. Mannitol injection was given to the patient to achieve the purpose of lowering IOP and reducing edema. Because of the more obvious symptoms of foreign body sensation and grinding pain in the eye, the patient complained of difficulty in sleeping and was agitated, he was instructed to take eszopiclone tablets and use timolol maleate eye drops and brinzolamide eye drops to relieve the discomfort. 1 week later, if the IOP control was stable and the symptoms were relieved, discharge from the hospital could be arranged for convalescence.
III. Treatment effect
The patient’s general condition was stable after 1 week of treatment with IOP-lowering, analgesic and antispasmodic drugs, and an ophthalmic examination was performed. The patient complained that the visual acuity of the left eye did not decrease again, the foreign body sensation and grinding pain disappeared, no left eye distension and pain, no headache, and was discharged from the hospital for recuperation.
IV. Precautions
The patient’s symptoms were relieved after admission to the hospital, and I was happy for her. In order to have a good recovery outside the hospital, the following points should also be noted.
1. The patient’s vision that has been lost cannot be restored after drug treatment, and the family should strengthen the care of the patient to avoid accidental injuries such as falls and bruises.
2, develop good sleep habits, regular rest and rest, ensure sufficient sleep, avoid staying up late and excessive eye use.
3.Family members should strictly follow the medical advice to assist patients with medication, not to increase or decrease the amount of medication on their own, and regularly go to the hospital to review the intraocular pressure, which is recommended once every six months.
V. Personal insight
The blindness caused by glaucoma is irreversible, such as the patient’s left eye perception (-) in this case, which cannot be improved by medication and will progress at any time with eye atrophy, infection and other problems, and if necessary, surgery is needed to remove the eye, and after removal, a prosthetic eye can be installed, which will not be affected in appearance. Family members should also strengthen the observation of the patient’s eye in life, and if there are manifestations such as infection and sunken left eye, they should seek medical attention in time to take the next treatment measures so as not to affect the normal function of the right eye.