Eye test reports are normal, but have some vision problem in left eye. Why ?

Question

Hi doctor,

My wife could not be able to see through her left eye. She has some pain near her eye like a headache, but there is no numbness or vomiting scenario. Now, her vision is at CF. We had our first visit before 10 days. The doctor did not find anything except the pressure is 29 and he suggested Tobramycin and Dexamethasone ophthalmic suspension for every six hours for a week. In the follow-up visit, the doctor found that her vision came down than earlier and the pressure raised to 40. He suggested an emergency MRI scan of the head, and it was normal. Then he suggested Travatan and Combigan and no cause identified. All these reports shared with our primary care doctor, and he advised to make another visit to the eye doctor and a neurologist checkup. As per his suggestion, we had another follow-up visit, and nothing found abnormal. They wanted to wait for a neurologist check, and until then my wife was asked to continue Travatan and Combigan. The report says everything is normal, but nothing is improved on her vision side. Can you please suggest us what we should do now?

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern. Please do not worry. In my opinion, there are two issues. One is Glaucoma and other is optic disc pathology. It can be a POAG, primary open angle glaucoma and the treatment is antiglaucoma medicine. If the pressure is normal and optic disc is normal, then glaucoma is under control, and it is not the cause of low vision. There is a very low vision in the left eye with RAPD (relative afferent pupillary defect) in left eye along and temporal pallor of the optic disc. It is suggestive of optic disc pathology and most likely optic neuritis (retrobulbar neuritis). The treatment plan will include dilated fundus examination which the doctor has mentioned that you refused it, please get it done. The other is Colour vision assessment of fellow eye which includes Visual field assessment (perimetry) of the fellow eye. MRI with contrast is the ideal investigation to look for demyelinating lesions in the brain as well as on optic nerve. Once the diagnosis is confirmed, we start high dose Methylprednisolone intravenously. Here, the prognosis is good, but some patients do not improve.