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The examination is normal, why is the right eye blind?
Writing | Li Pengwei
Strong> Patients fall on the left side of the patient, but the right eye is blind
The 62 -year -old Pharaoh accidentally from 3 meters from the construction site half a month agoFalling at a high place, the left side of the ground, was sent to the local hospital for emergency treatment by 120.After the injury, the left side of the face was active bleeding, and he was unclear for a brief consciousness. Eye -orbital CT shows the osteoporph structure of the left side of the left side, the bow, the inner and outer wall of the orbital orbital inner and outer orbital, and no obvious abnormality is seen in the nerves of both eyes.
Local doctors treat facial debridement suture while treating brain damage.6 hours later, the sober king found that his right eye gradually lost his light, and the local doctor felt very strange: obviously the left side of the left side caused the left eye to fracture. Why is the right eye blind?
In addition, the eye CT did not find Pharaohs right eye visual nerve injury.Although I feel uncomfortable, the doctor has relying on many years of clinical experience, and preliminary diagnosis is orbital fracture and retinal vibration, which has performed hormone impact and nutritional nerve treatment. But one week later, Pharaohs right eye vision still did not improve, so he came to the hospitals ophthalmology.
No abnormalities are seen in the bottom of the eye
show that Vision: There is no light in the right eye, 0.5 left eye.The left eyelid skin was bloody, with a small amount of scabs on the forehead skin, and the conjunctiva of the left eye was congested. There was no abnormalities in the rest.The depth of the right eyelid, conjunctiva, corneal, and front room is normal, and the room is negative.However, The pupils of the right eye are scattered, with a diameter of about 6mm, and the light reflection directly disappears, and indirectly reflects the light.
The doctor believed that there was a problem with the nerves or the bottom of the eyes with the experience of the doctor.The results showed that The right eye visited the nipple boundary clear, the color was normal, and there was no abnormalities in the macular area. The retinum was flat, no bleeding, edema, and exudation (Figure 1).Double intraocular pressure: 13mmHg.Both eyes are positive, and the eyeballs are unlimited.
Figure 1 Pharaohs right eye visual disk and macular are not seen abnormal
Although the right eyeThere is no abnormality in the bottom of the eyes, but the ophthalmologist still believes that Pharaoh has a lesion in the eyes or optic nerves, and the roughly rough datum -proof may ignore some details.As a result, the doctor conducted a more accurate OCT examination.However, the test results still show that the thickness of the macular structure and the nerve fiber of the right eye is normal (Figure 2).
Figure 2 Pharaohs right eye macular structure and vision plate nerve fiber thickness is not obvious abnormal
Pharaohs orbital magnetic resonance shows that the orbital walls are complete and the optic nervous tube is not abnormal.
The anatomical structure of the eye is normal, and the optic nerve has no edema or atrophy."Is Pharaoh in order to obtain more work injury compensation (pseudo -blindness)?" Ophthalmologists have drifted this idea for a moment, after all, peoples hearts are unpredictable.But he immediately denied his inference, because "the pupils were scattered and the light reflection disappeared" could not be disguised!Doctors have some difficulties at this time.
Smart readers, do you know what the patient should do next?What is the diagnosis of patients? Please Scan QR code below or click Read the original text Get the answer.
References:
[1] Wang Runbiao, Zhang Lizhi.2 cases [j]. China Practical Medicine, 2008,08: 157.
[2] The research progress of Li Xinyu, Guo Zhilin.Reconstruction of surgery, 2023,03: 315-318.
This article is first: Ophthalmology Channel in the medical world
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