Rashmi Priyanka M, S. Padmini , K. Mohan Raj
55 years old male presented to ophthalmology department in our hospital with the complaints of an insidious onset of gradually progressive visual loss and pain in right eye since 3 months. Left eye was normal. He was a non-smoker but alcoholic and is not a known case of hypertension. He was recently diagnosed with Diabetes mellitus and is a known case of dyslipidemia (Total cholesterol-234 mg/dl, TGL-269 mg/dl, HDL-30 mg/dl, LDL- 150.2 mg/dl, VLDL-53.8 mg/dl, Total cholesterol / HDL ratio- 7.80, LDL/HDL ratio- 5.01). After examination his visual acuity in right eye was PL negative, left eye 6/12 and near vision less than N36. On admission his pulse was regular, his blood pressure was 120/70 mmHg. Other systems were normal. The ocular position of both eyes on forward gaze was fixed at the midline and extraocular movements were normal. The anterior segment examination showed rubeosis iridis in the right eye. Left eye was normal. Intraocular pressure was 20.6 mm Hg in the right eye and 17.3 mm Hg in the left eye. A dilated fundus examination of right eye showed neovascularization of disc, superficial hemorrhages and absent foveal reflex. Multiple microaneurysms and superficial haemorrhages were present in the posterior pole extending up to the mid periphery along with few cotton wool spots (Figure 1). Left eye fundus was normal. Visual fields in right eye could not be done due to absence of perception of light whereas visual field in the left eye was normal. Carotid Doppler study showed right carotid bulb plaque with stenosis of 60% and bilateral internal carotid arteries showed echogenic material with minimal flow – suggestive of occlusion (Figure 3).
