Chopdar A
East Surrey Hospital, Redhill.
J R Soc Promot Health. 1998 Jun;118(3):173-5. doi: 10.1177/146642409811800309.
A 71-year-old male presented with a history of sudden partial visual loss in the right eye with an inferior visual field defect over the past 3-4 days. He had no history of headache or of facial pain. Clinical examination confirmed that vision on the right side was reduced to 6/18 and on the left to 6/12. The right eye showed a relative afferent pupillary defect. There was no other abnormality of the anterior segment of either eye. The right retina showed a pale swollen optic disc and a provisional diagnosis of anterior ischaemic optic neuropathy (AION) was made. An urgent erythrocyte sedimentation rate (ESR) was ordered and the patient was asked to return to the eye clinic in one month. However, 16 days later--when it was first recognised that his ESR was elevated to 75 mm in the first hour--the patient was recalled immediately in order to commence systemic steroid treatment; but regrettably, by this time, his right eye had become totally blind. In this case, although the attending doctor made a correct clinical diagnosis on presentation, he failed to act upon the result of the blood test.
一名71岁男性，在过去3至4天出现右眼突发部分视力丧失及下方视野缺损病史。他无头痛或面部疼痛病史。临床检查证实右眼视力降至6/18，左眼视力为6/12。右眼显示相对性传入瞳孔障碍。双眼眼前节无其他异常。右视网膜可见视盘苍白肿胀，初步诊断为前部缺血性视神经病变（AION）。当即紧急安排检测红细胞沉降率（ESR），并要求患者1个月后返回眼科门诊。然而，16天后——首次发现其ESR在第1小时升至75mm时——立即召回患者以便开始全身用类固醇治疗；但遗憾的是，此时他的右眼已完全失明。在该病例中，尽管主治医生在初诊时做出了正确的临床诊断，但他未根据血液检测结果采取行动。
