A long case presentation regarding Retinitis Pigmentosa

1. LONG CASE
PRESENTATION
Night Blindness --- 3 years
Dr. Muhammad Zeeshan

2. HISTORY OF PRESENT ILLNESS
A 42 years old male patient presented with gradually
worsening decreased vision at night from last 3 years
which was progressive with no aggravating or relieving
factors and not associated with any other symptoms like
pain, watering, floaters or any discomfort.

3. QUERY ?
What could be the Differential Diagnoses in this scenario?

4. DIFFERENTIAL DIAGNOSES
• Retinitis Pigmentosa
• Nutritional Deficiency (Vitamin A)
• Periphral Cataracts and Corneal Opacities
• Glaucoma
• Gyrate Atrophy
• High Myopia
• Certain Drugs (e.g Phenothiazines)

5. PAST OCULAR HISTORY
There is history of on & off use of spectacles otherwise no
previous history related to ocular disorders, trauma or any
other eye related surgeries.

6. PAST MEDICAL HISTORY
He gives an extensive history of Pulmonary Tuberculosis 2
years back for which he was prescribed some I/V medication
along with oral anti-tuberculous drugs after which he
developed significant deafness for which he didn’t take any
treatment.
Rest of history for any other medical illness is unremarkable.

7. PAST SURGICAL HISTORY
Patient gives history of road traffic accident 3 months ago in
which he sustained left forearm fracture which was managed
conservatively.

8. FAMILY HISTORY
Patient gives vague history of similar disease (decrease of
vision at night) in one of his 1st degree cousins.
Otherwise family history is insignificant.

9. PERSONAL & SOCIAL HISTORY
Patient is a shopkeeper by profession and father to 5
children.
He was a smoker but quit 1 year ago.

10. DRUG/ALLERGY HISTORY
Patient is currently not on any medication and he is not
allergic to any topical or systemic drugs.

11. SYSTEMIC EXAMINATION
A thin lean male is sitting comfortably on chair, of normal
height but decrease weight for his age/height, well-oriented
in time, person, place and with normal vitals.
His general physical and systemic examination is within
normal range.

12. EXAMINATION
Visual Acuity is
OD  6/12 P.H  6/12
OS  6/12p P.H  6/12
Near Vision N6 with +1.00DS in both eyes.
Color Vision intact for both eye.
Amsler Grid couldn’t be performed as patient’s pupils are
pharmacologically dilated.

13. EXAMINATION
On Torch examination:
Patient is orthophoric and pupil examination shows no
RAPD.

14. EXAMINATION
On Hand examination:
Relative constriction of periphral visual fields on
confrontation.
EOM full in both eyes , no deviation of eyes on cover/uncover
test.
IOP also normal digitally in both eyes.
Corneal sensations and cranial nerve exam intact.

15. DIRECT OPHTHALMOSCOPY
Red reflex: Normal in both eyes
Bilateral media clear.

16. SLIT LAMP EXAMINATION
Anterior Segment Examination:
Both eyes show normal anterior segments except for bilateral
early lenticular changes.
On Applanation Tonometry:
OD  15 mmHg
OS  12 mmHg

17. SLIT LAMP EXAMINATION
Posterior Segment Examination:
Right Dilated Fundus examination shows pale optic disc with
vascular attenuation, a dull macular reflex and a few bone-
spicules more prominent along the superior and temporal
arcade of posterior pole of retina.
Left Dilated Fundus examination shows the same picture
except of relatively milder degree.

19. FINAL DIAGNOSIS
Retinitis Pigmentosa

20. THANK YOU