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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Hi, Doctor Rick a family member aged 37 has been in hospital

Resolved Question:

Attachment: 2013-02-08_161220_new_doc2013020815300404620130208153004058.pdf

Attachment: 2013-02-08_161942_2.pdf

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Attachment: 2013-02-08_162108_4.pdf

Hi, Doctor Rick a family member aged 37 has been in hospital sin Monday, he was suffering from headaches for and eye soreness for a week previoust to going to the emergency room, attached are the retina scans of monday and today, the do not seem to know what the problem is, they have done a multitude of test blood , fluid from the spine, even malaria, and are treating hm with corticoids , they haven't founds infections or virus, need urgent expert advice, they say he could loose his sight, he has been in contact with dogs, puppies, so i thought toxocariasis

Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

I do not read spanish and I am unable to enlarge or rotate the scans, but judging on what I can see, your friend is suffering from a multifocal placoid choroidal epitheliopathy (AMPPE)

Dr. Rick :

There are a number of clinical causes for this condition but, unfortunately in most cases, the underlying issue for the autoimmune reaction is never found.

Dr. Rick :

Has you friend had a recent flu-like illness?

Dr. Rick :

In the pictures you provided I do not see any problems with the retinal blood vessels so tat is a good sign.

Dr. Rick :

I see a fluorescein angiogram was not done due to nausea; I would probably pre-treat him with benadryl and do the angiogram if possible as it will provide additional data.

Dr. Rick :

Are you available to chat?

Customer:

yes

Dr. Rick :

Hi. Does this make sense to you so far?

Dr. Rick :

I am a retina specialist so this is what I do on a daily basis......

Customer:

they will do the test on monday

Customer:

he was a bit ill last week

Customer:

maybe 10 days ago

Dr. Rick :

Ok. If they are not sure of the diagnosis, a workup can be done looking for other diseases that can have physical findings like this. In my practice, I rarely need to do an extensive workup as, in my experience, this condition is self limiting and no treatment is needed.

Dr. Rick :

One thing, however, since he has bad headaches, I would suggest an MRI since, in a minority of patients, the same process can go on in the brain (microvasculitis)

Customer:

im worried they docs are lost here, they main doctor is not an eye doctor she is internal medicine is that normal,

Customer:

the did do an MRI no problems found

Dr. Rick :

He does, however, need to be followed as in some patient, late in the course of the disease, abnormal blood vessels (choroidal neovascular membrane) can form and these need to be treated quickly to prevent vision loss.

Dr. Rick :

If they are not retina specialists, I can see how they might be lost.....

Dr. Rick :

I do not do heart attacks, and internal medicine doctors should not do eyes....especially retina :-)

Dr. Rick :

There is no need for an internist here, especially since the MRI was normal. Your friend would do best with a very well rounded general ophthalmologist or a retina specialist like myself.

Customer:

can you recommend someone in spain, is there somewhere I can look,

Customer:

are you in Europe

Dr. Rick :

The good news? In the vast majority of patients vision returns to normal, in the range of 20/20 to 20/40 although some do have long term vision changes due to scotoma (small blind spots)

Dr. Rick :

No. I am in the USA.

Dr. Rick :

Any retina specialist or University Teaching Ophthalmology program could help your friend.

Dr. Rick :

Moorfield's Eye Hospital in London is one of the best eye hospitals in the world.

Dr. Rick :

From what I have seen in your post I am fairly confident that your friend has APMPPE.

Customer:

other that corticoids should they be contemplating any other drugs

Dr. Rick :

But, that being said, he needs to see someone who knows what is going on as the differential diagnosis list is rather extensive and needs to be considered in total.

Customer:

ok thanks, XXXXX XXXXX in the hospital until monday , they will only release all the documentation when he leaves

Dr. Rick :

I do NOT recommend steroids -- they have shown to be ineffective in these cases.

Dr. Rick :

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

Dr. Rick :

My pleasure. Give my best to your friend.

Dr. Rick :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick MD FACS

Customer:

what treatment should they be considering

Dr. Rick :

Have a retina specialist see him to make sure of the diagnosis. If what I believe is true, no treatment is indicated, other then close monitoring (at one week, two weeks later, one month later etc...).

Dr. Rick :

Sounds like the doctors are not sure what to do so they just think throwing steroids at the issue and seeing what happens is the way to go......not a good idea.

Customer:

ok thanks for your help

Dr. Rick :

my pleasure.

Dr. Rick :

 


It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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Expert:  Dr. Rick replied 1 year ago.
Hi Sam,

I was just thinking about your friend and wondering how he is doing. Has he been able to be evaluated by a retina specialist yet?

If the managed to obtain a fluorescein angiogram I would be happy to review it for you.

Take care and give my best to your friend.

Dr. Rick MD FACS

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