Case presentation

By: Imtiaz ur Rehman4th Year MBBS

Khyber Medical College Peshawar

Learning objectives• Sudden loss of vision• Sudden onset of

double vision• Swollen optic disc• Ocular injury• Child with white

pupillary reflex• Red eye

• Pain in the eye• Progressive dec in

vision• Child with squint• Swelling of eyelids• Watering of eye

• 7 yrs old boy with complain of misalignment of eyes from past 7-8 months

• No Hx of trauma, fever and fits

• Diplopia

Examinations• Visual acuity

RE= 6/6LE= 6/9 (improved with pinhole)

• PupilNormal and reactive to light

• Ocular movementsLimitation of abduction on left eyeLimitation of left levoelevationLimitation of left levodepression

• Distant direct ophthalmoscopy• Red reflex present

• Direct ophthalmoscopy• Normal optic discs and fundi

• Digital tonometry• Normal IOP in both eyes

• Visual field• Eyelids

• Normal

Tests performed for squint Hirshberg test

(15degrees)Krimsky test

(30 PD)Head turn(to left side)

SQUINT

Non functioning Left lateral rectus muscle

Sixth cranial nerve palsy

Due to

Due to

Course of 6th nervePons

Ponto medullary junction

Cavernous sinus

Superior orbital fissure

Orbit

Causes of sixth nerve palsy• Diabetes• Hypertension• Inflammation• Raised ICP• Trauma• Tumor

MRI scan

MRI report

Treatment• Removal of GliomaCurrent treatment

• Acetazolamide (AZM)• Deltacotril• Risek satchet 40 mg