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Thursday, 28 November 2013

Glaucoma – Misdiagnosis

Glaucoma is a medical condition of an eye disease as result of the damage of the nerve of eye’s optic over time. If left untreated, it can lead to permanently vision impair and blindness.
A. Misdiagnosis
1. Scleral buckling dislocation
There is a report of a 71-year-old man with severe permanent optic nerve damage due to previous misdiagnosis of a rare complication of scleral buckling surgery but as misdiagnosed as glaucoma progression(17).
2. Optic neuropathy secondary to compression of the anterior visual pathway
There is a report of a series of six patients who had been receiving treatment for normal tension glaucoma (NTG; five patients) or primary open angle glaucoma (one patient). All of them were found to have optic neuropathy secondary to compression of the anterior visual pathway(18).
3. Chiasmal compression
Routine neuroimaging for patients with presumed normal-tension glaucoma (NTG) is a contentious issue and it has been suggested that it may be unnecessary due to the low yield for detecting intracranial pathology. There is a report of 8% of patients diagnosed with NTG have associated compressive lesions of the anterior visual pathways(19).
4. Other cases of misdiagnosis
a. Spinal stenosis
There is a report of a case of a 66 year old woman was admitted to the orthopaedic ward for elective spinal canal decompression for spinal stenosis, but the diagnosis of bilateral angle closure glaucoma was evebtually made, due to symptoms of visual loss, a red eye, both eyes were red with cloudy corneas; shallow anterior chambers; fixed, mid-dilated pupils; and high intraocular pressures of 45 mm Hg in the right eye and 33 mm Hg in the left eye (normal <21 mm Hg), etc.(20).
b. Left conjunctivitis
There is a report of a case of a 80 year old woman was admitted to the medical ward with sudden onset of severe left periorbital pain, frontal headache, and blurred vision in the left eye. She was diagnosed as having left conjunctivitis, treated with chloramphenicol eye drops, and discharged. 4 months later, she was readmitted after a fall and treated on the medical ward for a urinary tract infection. During admission, she complained of left eye pain and headache of four months' duration. The left eye was red, and the left pupil was dilated and slowly reactive. An ophthalmic examination revealed Snellen visual acuity of no perception of light in the left eye and 6/9 in the right eye, left corneal oedema, shallow anterior chambers, and intraocular pressures of 48 mm Hg in the left eye and 12 mm Hg in the right eye. A diagnosis of left angle closure glaucoma was made, and the standard medical regimen was started(20).
c. Hyperglycaemia and sepsis
There is a report of a 77 year old woman with angle closure glaucoma, but was misdiagnosed as hyperglycaemia and sepsis, treated with benzylpenicillin and ciprofloxacin, and given a diet to control her diabetes.Then misdiagnosed again as conjunctivitis and and was treated with chloramphenicol eye ointment by the ward physicians and referred as a non-urgent case to ophthalmology(20).
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