ABSTRACT
PURPOSE: To present a case of chronic progressive external ophthalmoplegia (CPEO) diagnosis in the setting of a busy glaucoma clinic. MATERIALS AND METHODS: Case report. RESULTS: A 70-year-old-female presented to our glaucoma clinic concerned on her glaucoma status. She was previously followed-up elsewhere. Her past ophthalmic history included a diagnosis of normal tension glaucoma 10 years earlier for which she was on topical anti-glaucoma medication. On inspection, symmetrical ptosis was noted and when she was asked about her family history, she reported that 4 members of her family had "problems with moving their eyes" as she also had from a young age. Her best corrected visual acuity was 20/100 in her right eye (RE) and 20/80 in her left eye (LE). Optic discs had normal margins with peripapillary atrophy and cup/disc ratio was 0.7 RE and 0.8 LE. Intraocular pressure was 10mmHg bilaterally. Ocular motility examination revealed severe restriction in all directions of gaze. She had mild alternating exotropia but she did not report any diplopia. Based on her family history, bilateral ptosis, ophthalmoplegia and reported symptoms, the diagnosis of CPEO was made. CONCLUSION: In the setting of a busy subspecialty clinic, it is common for clinicians to focus on a specific pathology and overlook additional signs and symptoms that represent a second often unrelated condition. Our case highlights the importance of a thorough assessment including history taking (general, ophthalmic and family), good documentation of symptoms and an adequate clinical examination.
ABSTRACT
PURPOSE: To evaluate contrast sensitivity in children and adolescents with diabetes mellitus without evidence of diabetic retinopathy. METHODS: Sixty patients with insulin-dependent diabetes mellitus (age range: 8 to 18 years) were studied. Their contrast sensitivity scores were obtained using the CSV-1000 device (Vector Vision, Dayton, OH) for four spatial frequencies and were compared with v scores of 45 age-matched and gender-matched "healthy" patients. Contrast sensitivity values were also correlated to patient's age, duration of disease, and metabolic control of diabetes mellitus. RESULTS: The patients with insulin-dependent diabetes mellitus had a significant contrast sensitivity score reduction at all spatial frequencies tested. Glycosylated hemoglobin levels were inversely related to the contrast sensitivity thresholds. No significant correlation was found between the contrast sensitivity scores and the patient's age or duration of disease. CONCLUSION: Contrast sensitivity defects are detected in patients with insulin-dependent diabetes mellitus. These defects may represent an early dysfunction of the retina, visual pathway, or both in patients with insulin-dependent diabetes mellitus who do not show any signs of diabetic retinopathy.