Mei jie (F/46) came for eye examination to make a new pair of glasses for driving. She is under thyroid medication now, just diagnosed & started 3 months ago when her weight came down a lot that prompted her to go for a body check. She presents with a significant head tilt to right, and she said she also realises that her head has come down to her right, and jokingly being pushed back upwards by her friends.
Examination shows:
R: +0.50/-1.75×75 (6/7.5-) PHNI
L: -0.25/-1.25×115 (6/7.5-) PHNI
Add: +1.75 (N5@40cm)
She sees double vision with both eyes opened, she tilts her head to right, no double vision is seen. If she covers one eye, no double vision is seen.
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test) by looking at a target alphabet
RE Hypotropia & Exophoria @Distance & Near *she told us the target goes up & down
(normal value: Orthophoria/NMD-No Movement Detected or small XP small recovery)
Hyper = is misalignment of the eye, eye is deviated upwards
Hypo = is misalignment of the eye, eye is deviated downwards
Exo = is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment (Corneal Light Reflection Test – Hirschberg)
RE corneal reflex on superior part of eye
Examination of Eye Alignment (Maddox Rod)
Distance : only spotlight is seen, line is not seen (RE vision suppression?)
Examination of Eye Alignment (Modified Krimsky)
Distance : LE 4BU
Near : LE 2BU
(prism: BU=base up)
Examination of Eyes Muscles (Ocular Motility Test, OMT)
Right eye: movement restriction on elevation, Left lid lag on downgaze
(normal value: SAFE – smooth, accurate, fast, extensive)
Examination of Gross Side Vision (Confrontation)
R: FULL
L: FULL
(normal value: FULL)
Colour Vision
R: normal
L: normal
Pupil Reflex
R: PERRLA, -RAPD
L: PERRLA, -RAPD
(normal value: Pupil, Equal, Round, Responsive to Light & Accommodation, PERRLA, -ve Relative Afferent Pupillary Defect, -RAPD)
Examination of Slit Lamp Microscope
puffy lids (both eyes)
fluorescein -ve
mild yellowish on lens
Mei jie is seeing double vision, she has her head tilted to avoid seeing double vision.
Referral letter has been given to her to see eye doctor/ophthalmologist.