Game 8
set-up
Jack and Jill walk into your clinic. They present with different issues.
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For one, Jack looks like he is walking around with one eye. His left eye is completely white and somewhat blue from a distance, and yet he keeps rubbing his right eye as if in pain.
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Jill on the otherhand seems to have a fairly normal eye, yet her cornea seems to be sort of sparkling? She insisted on pain and slight photophobia. As a health care professional, you take on the task.
solve
in
1
You first take a look at Jack.
His left eye is considerably white, and he seems to have bumps over his body.
He explains he has lost vision completely in his left eye ever since he visited Africa. After taking history a bit longer, you realise that since his return, he has had an incredibly long sore throat, and deteriorating vision mainly in the left eye.
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His right eye appears slightly red. Checking the retina, you see a white retinal scar, surrounded by pigments.
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Jill is next. The sparkling was keratic precipitates. There appears to be cells floating in the anterior chamber, yet the corneal epithelium seems untouched. That is except for this random line near the limbus
solve
in
2
You put on a diffuse beam and scan Jack's left eye and sure enough you find what you were looking for. You proceed to ask Jack a couple more questions.
"I guess there were a lot of flies, and animals everywhere. It was a fun trip don't get me wrong, I feel like it was maybe something I had on the plane home."
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It is definitely not something on the plane home.
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You focus your slitlamp onto the endothelial layer of Jill's eye. Sure enough, the line becomes clear, along with the stromal infiltrate that is peripheral to the line.
last chance
You finally prescribe and diagnose.
You tell Jack to go see a doctor about his left eye, and his right eye should slowly resolve itself, but he should still talk to a doctor about it.
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For Jill, you prescribe her topical corticosteroids and antivirals to help with her condition.
The answer
Jack had Ocular Onchoceriasis and Toxoplamic Retinopathy
Jill had HSV Linear Endotheliitis
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- Onchoceriasis or river disease is caused by the onchocerca parasite
- The microfibriae navigates to ocular tissue and then dies, which causes visual impairment. This then drastically diminishes life to a 10 year life expectancy.
- Toxoplasma Gondii is obtained through contaminated foods that may have been in contact with faecal matter. The body's immune system is typically strong enough to suppress it, but not if it is immunocompromised. The ocular damage is usually visible through the retina.
- HSV Linear Endotheliitis has a line of keratic precipitates, and a peripheral to limbal oedema. Can have flare, pain, photophobia, and is treated with topical corticosteroids and antivirals.