DIGITAL GRAND ROUNDS

'Bags' Under Eyes, Obesity
Give Clues to Diagnosis

by Walter A. Mayo, O.D.

A 72-year-old white female came to the clinic with complaints of "bags" under her eyes. She stated that she did not have any significant vision problems except that she needed over-the-counter reading glasses to read the Sunday paper.

She reported no health problems, but mentioned that she had leg cramps at night, and that she was frequently tired. Family history was unremarkable.

This is how the "bags" under this patient's eyes appeared upon presentation.

"How would you approach this case? Read on for further details about the visit. Then test your clinical skills by clicking here for the answer and clicking on Case 112, or by calling our Digital Grand Rounds phone line.

Uncorrected visual acuity at distance was 20/30+ in the right eye and 20/40 in the left. Refraction yielded no real improvement. Color vision was normal. Extraocular motilities were normal. Pupils were normal. General observation showed the striking appearance seen in the accompanying photo.

Biomicroscopy showed mild nuclear sclerosis in both eyes. Anterior chambers were clear and the angles were deep. Dilated fundus examination was also normal in both eyes. Intraocular pressures were 20mm Hg in the right eye, 15mm Hg in the left.

The patient was significantly overweight, with distinct swelling and folds of skin on her legs and ankles. 

What is your diagnosis? How would you manage this patient? Are there any additional tests that you would like to perform?

For answers, follow the instructions in the box below.

Dr. Mayo, a private practitioner in Georgetown, S.C., is technology director for the Southern Council of Optometrists. You may contact him at waltmayo@aol.com or waltmayo@sccoast.net.

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