77/F WITH DECREASED VISION SINCE 7 MONTHS

77/F DECREASED VISION SINCE 7 MONTHS

This is an online E - log book to discuss our patients de-identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patient’s clinical problems with collective current best evidence based inputs. 
This is Srujana Yadavalli (192) of 2019 batch.


This is a case of 77 y/o Female with decreased vision since 7 months.She was referred from opthalmology dept to genmed dept as she had high blood glucose levels (of 558 mg/dl )which was found during the prerequisite screening for cataract surgery.


History of presenting illness-

The patient was apparently asymptomatic 1 year ago when she had h/o nocturia(>4-5 times),increased frequency of urination and thirst due to which she went to the hospital and was diagnosed with diabetes and was given medications.
H/o increased appetite 
H/o silvery white patchy lesion over left foot associated with itching sensation.
H/o itching sensation on face,neck,palms and groin region.
H/o diminished vision since 7 months which was insidious in onset ,gradually progressive associated with lacrimation and irritation.no h/o redness and photophobia.
No h/o weight loss

Past history:-


She's a Known case of hypertension since 1 year and is medications
Not a known case of TB, asthma, epilepsy,cvd, hyperthyroidism 


Personal history : 

Mixed diet

Appetite is reduced 

Normal bowel and bladder movements 

Sleep is adequate 

No Addictions and allergies


Daily routine:-
Before -
5;30am -  wakes up
5;30-7:30am - walks for a km to get milk and deliveries it to her eldest son 
7:30-9:30am-  brushes her teeth,baths and eats rice and drinks chai.
10am-1pm - sits in the shop (owned by her son)
1-1:30pm -eats rice again with dal and curry
2-4pm - sleep and rest
5-9pm -spends time with family and neighbours
9:00 -9:30 pm - dinner
10pm - sleep

After the diagnosis -

Her routine remains the same ,except she takes her medications for diabetes and hypertension after taking her food.
She stopped taking rice for breakfast and dinner and substituted it with millets and jowar.
She also stopped adding sugar to her chai/coffee.


Family history: -

History of DM and HTN  in her elder sister and younger brother.

General examination -


Patient was conscious ,coherent and well oriented to time and place.
Patient was moderately built and nourished 

No pallor 
No icterus
No cyanosis
No clubbing
No edema
No lymphadenopathy

Vitals

BP 140/90 mm of Hg

Pulse 80beats /min

Temperature -afebrile

Respiratory rate 17 cycles/min


Examination of-
Eye: 



Gradual Diminision of vision in the right eye 

Ocular movements are not limited 

                              Right eye                     Left eye

Visual acuity         Counting fingers, 2m.       6/60

Lids.                           normal               normal

Conjunctiva             Muddy.                    Muddy

Cornea             nasal pterygium     nasal pterygium

Anterior chamber PACD = 1/2 CT   PACD = 1/2 CT

Iris                        normal.                     Normal

Pupil          normal size, reactive.        normal size, reactive

Lens                   IMSC grade I - II      



Examination of skin-


single well defined  ,Silvery white plaque noted over the left foot on the medial aspect.

No associated swelling,discharge and redness





Systemic examination:



CVS- S1 S2 heard. no murmurs

CNS- No focal neurological deficit

RS- Normal vesicular sounds heard

P/A- 

scaphoid abdomen 
Central obesity+
non tender, no palpable mass

bowel sounds heard 










Provisional diagnosis -
Metabolic syndrome 




Investigations-





Management -

Advised to stop consuming cookies and cold drinks.

Medical -
tab. LOSARTAN 40 mg 
Injection Human Actrapid 10 IU given before each meal 
Inj. NPH 8 IU twice daily 
Glimipiride 10 mg
T.teczine 10 mg
Clotrimazole 1%
Halox ointment twice daily



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