Optometry case study: Pituitary cyst

645

by Jenny Lanham, Specsavers Marion – South Australia

History

A 78 year old female presented in August 2009 complaining of
blurry vision R>L. She also reported having to blink more frequently
to see clearly.

POH – She had a history of dry eye and MGD. Also small scattered
drusen on both fundi for > 20 years. Referred to ophthalmology
2004 due to disc cupping and discharged.
FOH – mother glaucoma, cataracts, diabetic retinopathy.
GH – excellent, no meds.

Examination

RE: -0.25 VA 6/12
LE: -0.50 VA 6/6
External eye – mild dry eye R&L
Media – RE Nuclear 2, Cortical 3
LE Nuclear 2, Cortical 2
Maculae – fine drusen as before
CD ratios – 0.8 vertical, 0.6 horizontal in both eyes
IOP’s RE 15mm Hg, LE 17 mm Hg

Diagnosis

Management

Referred for cataract surgery right eye which took place Dec 2009.
Ophthalmology reviewing optic nerve head appearance.
Post cataract extraction Jan 2010:
RE: plano VA 6/12
LE: -02.5 VA 6/6

Fields

May 2010

 

 

 

 

 

 

Referred to neuro-ophthalmology and subsequently for an MRI

Diagnosis and treatment

Pituitary cyst diagnosed and drained by neuro surgeon.

Re-examined

September 2010
VA 6/6 right and left
Significant improvement in visual fields in both eyes.

September 2010

 

 

 

 

 

Discussion

Pituitary tumours are common and have been found to be present in up to 26% of patients with no history of pituitary disease in autopsy studies. In over 99% of cases these tumours are benign but can still cause problems because of their size. The most common symptoms are headache and loss of peripheral vision (from compression of the optic chiasm).

In this case the patient had a pituitary cyst, a specific type of tumour. About 90% of pituitary tumours are successfully treated with tablets, the remaining 10% will need surgery and possibly radiotherapy. Having a pituitary tumour should not reduce life expectancy.

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