A Case of Retinal Detachment of a 15 Year Old, Prognosis...Bad

How are things going for us all? The Harmattan here is taking its time and being quite gentle with us as compared to the previous year, I am still planning on getting some shea butter to use for when it gets scorched though.

As the days go by more indicators become apparent that Christmas is drawing near, soon the carols of bells will be sounding and we will be attending to baby Jesus in the manger until then though, I believe it is incumbent on us to learn and make the most of the knowledge and skill we acquire on the blockchain.

Today I would like to share a case report of one of my patients who came in today for her review, the results were quite sad and I had to make a referral to a specialist for further care, i believe that things could have turned out better if my patient had done better by coming in earlier. I hope we all learn something from this though.

Our Patient Today is a 15-year-old girl who came in for her first consult on Tuesday, 12th of December, 2023. Her complaints were that her vision suddenly dropped about 4 days before her visit and her eyes were aching, she also noticed the eyes had become red so her Dad went to the drug store to buy eyedrops for her to use.

Her Dad got her Chloramphenicol eye drop which is an antibiotic and after using it for 4 days there wasn't any improvement in her vision so they decided to visit the Hospital to see what was wrong. The General Practitioner referred them to me for evaluation which I did accordingly.

Her eyes indeed were reddened however aside from this the exterior part of the eye seemed to be in good condition, and nothing out of the ordinary was noticed internal examination of the eye reviewed a hazy vitreous, the media leading to the retina. The retina itself seems to have blurred out and the optic disc couldn't be focused much like what is seen in optic neuritis. The haziness of the vitreous also gave the differential of posterior uveitis.

Because both differentials were sight-threatening and had the possibility of causing blindness I went ahead to start managing the inflammation with steroids and oral antibiotics as well as topical steroids, I referred for an ocular coherence tomography test to confirm the retina's integrity for which they ought to have been reviewed the next day however they could only come in today.

Unfortunately, the scan showed that the retina had detached and it looks like it has been detached for a while now, possibly even before they came in for care. Retinal Detachment is considered an ocular emergency because the longer the detachment stays as such the worse the chances of getting vision back and already her vision has deteriorated such that she can only see my fingers when I am standing a meter away from her.

Although the prognosis is bad due to the time of diagnosis I made a few calls and referred her to see an Ophthalmologist for us to explore the chances of immediate surgery if there is any chance we could salvage some of her vision. An appointment has been booked and I await feedback however chances that things could go very well are quite low, prognosis is indeed bad.

Further Reading

_{Steel D. Retinal detachment. BMJ Clin Evid. 2014 Mar 3;2014:0710. PMID: 24807890; PMCID: PMC3940167.}

_{Solinski MA, Mylvaganam H, Adenwalla M, Ghadiali Q. 13. Tractional retinal detachments. Dis Mon. 2021 May;67(5):101142. doi 10.1016/j.disamonth.2021.101142. Epub 2021 Jan 28. PMID: 33516570.}

_{Uy HS, Yu-Keh E, Chan PS. Posterior Uveitis. Dev Ophthalmol. 2016;55:163-6. doi: 10.1159/000438968. Epub 2015 Oct 26. PMID: 26502276.}

_{Bennett JL. Optic Neuritis. Continuum (Minneap Minn). 2019 Oct;25(5):1236-1264. doi: 10.1212/CON.0000000000000768. PMID: 31584536; PMCID: PMC7395663.}