It is not often that an eye surgeon is able to awe a room full of medical students and residents in a busy Ophthalmology clinic.
👀.
So I'll take this opportunity to write a thread 🧵 about this extra-ordinary accomplishment. 🤩 1/
👀.
So I'll take this opportunity to write a thread 🧵 about this extra-ordinary accomplishment. 🤩 1/
An 18yr old male patient was referred to me. He came in with complaints of a swelling on his left eyebrow since last 3 mts. He had gone to several doctors of different specialties before me & had several differentials ranging from “Sebaceous Cyst” to “Dermoid cyst”! 🤷 2/
At first look it did seem one of those differentials was right. On examining though, texture appeared like classical "bag of worms" sign. I asked for history including leading questions of specific signs which would confirm what I suspected. All negative! 3/
The clincher on slit lamp in 👁 exam!
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Lisch Nodules
Yellow to brown coloured melanocytic harmartomas- dome shaped projecting out of iris which are harmless and don’t affect vision. However they are present in up to 94% of some cohorts of Neurofibromatosis type 1 (NF1). 4/
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Lisch Nodules
Yellow to brown coloured melanocytic harmartomas- dome shaped projecting out of iris which are harmless and don’t affect vision. However they are present in up to 94% of some cohorts of Neurofibromatosis type 1 (NF1). 4/
I repeated my questions about other signs of NF1.
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Café au lait spots-flat brown medium-large skin spots in the body. 6+ spots is strongly indicative of NF1.
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Neurofibromas- Small pea-sized bumps on the skin mostly at the back.
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All denied again. 5/
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Café au lait spots-flat brown medium-large skin spots in the body. 6+ spots is strongly indicative of NF1.
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Neurofibromas- Small pea-sized bumps on the skin mostly at the back.
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All denied again. 5/
However, I was confident enough about the diagnosis to ask him to lift his shirt so that I could examine his back.
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I think I heard a collective gasp of awe behind me from the medical students/interns/residents who were watching. 6/
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I think I heard a collective gasp of awe behind me from the medical students/interns/residents who were watching. 6/
The café au lait spots and few neurofibomas spread across his back.
NF1 confirmed! 7/
NF1 confirmed! 7/
Patient advised for imaging to exclude other features of NF1.
Patient also advised for excision of left brow plexiform neurofibroma with brow-pexy to correct the cosmetic blemish and restore symmetry of the face! 8/
Patient also advised for excision of left brow plexiform neurofibroma with brow-pexy to correct the cosmetic blemish and restore symmetry of the face! 8/
The eyes don’t see what the mind doesn’t know!
In this case, look at the eyes for clues when positive history is not forthcoming! 9/
In this case, look at the eyes for clues when positive history is not forthcoming! 9/
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