Hello and welcome to Case of the Day. I’m Dr. Croley and today we’re gonna talk about a patient who came in with a disease called phthisis bulbi. It’s a pretty weird name. So it’s spelled p-h-t-h-i-s-i-s, then bulbi, b-u-l-b-i. So basically what phthisis bulbi is that this person had an eye that’s just basically scarred and lost all integrity, and just not deceased and sick in state, sick eye.
From the history of this patient, it appears that probably she had a central retinal vein occlusion; that is the vein that drains the blood out of the back of the eye got clogged up like thrombosis, like getting a thrombosis on your leg. So this vein clogs up so that all the hemorrhaging occurs inside the retina.
What happens with central vein occlusion is in the ischemic type, that is, there’s also a loss of blood flow into the eye, then you get a proliferation of abnormal vessels in the eye. These vessels can grow up to the front of the eye into the iris, block off the angle where the fluid drains out of the eye and cause probably the most severe type of glaucoma called neovascular glaucoma, which means blood vessels, vascular new blood vessels have now clogged up the drainage system totally and these are very difficult cases to handle.
She evidently had some operations on her eye from glaucoma, but were not successful, which is pretty typical. So her cornea, because this is a sick eye, had scarring of her cornea which is no longer clear, and her eye is all red and inflamed. Actually her pressure was zero inside the eye. So the ciliary body here behind the iris produces fluid that fills up the eye and goes up into the front of the eye, then drains out. Her eye is so sick that this is not really producing any fluid anymore. The pressure inside the eye is zero. A normal eye has a pressure of about 10 to 21. So what happens when the pressure is that low and the eye is that sick and inflamed, it becomes painful. So she came in because her eye is painful and not because of how sick her eye is.
So the treatments are, in the beginning you do simple things, so sometimes we put these people on prednisone, which is an anti-inflammatory that calm the eye down and try to give them pain relief. Sometimes that’s not quite enough, then we also use sometimes anti non-steroidal anti-inflammatories like Advil that’s not an eye drop, and that can be used to try to decrease the inflammation and decrease the pain, the pain-relieving aspects of the medicine and decrease the pain in the eye.
And then if that’s not enough, and they have severe pain which does occurs in some patients, then one choice is to do a block, that is to do an injection behind the eye to block the nerves going to the eye with absolute alcohol. The alcohol kills the nerves so it blocks the pain, but unfortunately, that typically the nerves regenerate some and typically, the pain returns with alcohol blocked. So really haven’t done those recently at all, but I used to back in.. many years ago.
And then the last thing is if it’s that painful and intolerable, then actually we sometimes on occasion have to remove the eye to stop the pain.
So phthisis bulbi is basically the eye is so sick that there is no pressure in the eye, there’s inflammation in the eye, the eye may be has a scar tissue on the surface of the eye and they can become very uncomfortable and we try to treat it conservatively at the beginning but it could lead to actually removing somebody’s eye.
So if you have any questions about any type of eye problem, I’d be happy to answer those. If not, may God grant you healthy eyes and great vision.