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History
A 59-year-old white female reports to our clinic for her six-month follow-up to monitor her fundi for Plaquenil toxicity. She has no visual complaints at this visit.
Medical history:
- Rheumatoid arthritis
- Type 2 diabetes mellitus (blood sugar not under good control)
- Transient ischemic attacks
- Hypertension
- Hyperlipidemia
- Asthma
- Thyroid dysfunction
- Sleep apnea
- Peripheral neuropathy
- Gastroesophogeal reflux
Medications:
- Plaquenil--200mg bid; taken for almost 2 years
- Diovan, Crestor, Tricor, ASA, Avandamet, Advair, Synthroid, Lorazepam, Depakote, Neurontin, Prednisone, Ultracef, Axid, and MiraLax
- Nutritional supplements: Vitamin E and calcium
Examination Findings
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Visual acuity: 20/20 OD, OS |
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Amsler grid:
- Red-on-black
- Temporal defect OD
- No defect OS
- White-on-black
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Red-on-Black Amsler Grid
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Temporal Defect OD
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Within Normal Limits OS
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White-on-Black Amsler Grid
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Within Normal Limits OD
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Within Normal Limits OS
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Slit lamp exam:
- No corneal deposits OU
- No rubeosis OU
- Grade 2 NS cataracts OD, OS
Internal Ocular Examination:
- C/D ratio: 0.35/0.35 OD, 0.45/0.5 OS; healthy rim OU
- Dark, grainy maculae OD, OS
- No foveal light reflex OD, OS
- No bull's eye maculopathy noted OD, OS
- No diabetic retinopathy OD,OS
- Peripheral retinal unremarkable OU
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Fundus photography:
No bull's eye maculopathy OD, OS
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Color vision testing:
- Ishihara Testing
- Waggoner HHR Blue/Yellow Subset Plates
- Medium B/Y defect OD
- Strong B/Y defect OS
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Visual fields: |
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Overall decreased sensitivity OD, OS on 10-2 visual fields (white on white)
[Click image for full visual field printout; will appear in different window] |
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VF results one month after starting Plaquenil; red target.
An overall depression is noted in both eyes.
[Click image for full visual field printout; will appear in different window] |
Go to: Plaquenil Toxicity Without Bull's Eye Maculopathy CE table of contents
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