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Answers: 2011 Series - December 13, 2011
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Lecture 3 of 52 NEXT»
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| This 60-year-old man presented with a lifelong history of poor vision. He also noted that his eyes were in constant motion moving back and forth. His vision has been poor since childhood. Visual acuity at the present examination was measured at 20/200 in each eye. Refraction did not lead to improved vision. The anterior segment and media were within normal limits. The retina appeared as shown in the pictures. |
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How would you describe the appearance of the retina of each eye? |
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d -- The retinas look normal.
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| 2. |
The likely diagnosis in this case is: |
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d -- congenital nystagmus
Pendular nystagmus present from very early in life, with a normal looking retina, is a sign of congenital nystagmus.
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| 3. |
An additional test that would be useful is: |
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c -- electroretinogram
An electroretinogram would provide information about retinal cellular disorder.
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This case was presented for E-Consultation. The neuro-ophthalmologist mentor provided the following advice for this patient:
“Your patient has congenital nystagmus. In the past this form of nystagmus has been called sensory defect nystagmus. This implies that in addition to the nystagmus, which can decrease visual acuity, there is probably a disorder of the visual sensory system which is damaging visual functions. The optic nerves and the retina of this patient look normal. You might consider obtaining an electroretinogram to look for retinal cell disorders.”
Additional comment: While surgery is done in some cases of nystagmus, it is usually reserved for cases where the eye movement causes the reduction in vision. In cases where reduction in vision causes nystagmus, quieting eye movement could reduce visual efficiency if the “panning” of the environment provides more information.
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