Advanced glaucomatous visual loss and oral steroids

Case report

A 63 year old man attended his usual optometrist in April 2005 complaining of gradual difficulty in focusing with his right eye over two months. The optometrist found raised intraocular pressures, cupping of the optic disc, and visual field loss and referred him urgently to hospital. At the hospital consultation his Snellen’s visual acuity was 6/12 right with an afferent pupillary defect and 6/6 left. Colour vision testing was not performed. Intraocular pressures (normal range 10-21 mm Hg) were 31 mm Hg right and 26 mm Hg left with wide open anterior chamber angles. Anterior segments were otherwise normal with no evidence of cataract. Ophthalmoscopy showed advanced glaucomatous cupping of the optic disc, with a cup to disc ratio (normal <0.5) of 0.9 right and 0.8 left (fig 1⇓). Computerised visual fields confirmed advanced glaucomatous field loss in the right eye and moderate loss in the left eye (fig 2⇓).