Harvey’s Hemorrhage

We all have favorite long-standing patients in our practices, and Harvey is one of mine.  He’s been coming to us since 1997.  His early visits were routine but in 2004 he developed periorbital pain in the left eye due to orbital cellulitis, likely caused by his chronic sinusitis – and diplopia as a result of a left abduction deficit due to erosive inflammation in the orbit.  He responded poorly to oral prednisone and much better to CellCept, experiencing a recurrence of his cellulitis after being taken off the medication the first time.   We used yoked prisms, but Harvey had such restrictions of gaze that he frequently resorted to patching one eye.  He was resistant to any form of vision therapy.  We ultimately referred him for eye muscle surgery which greatly improved his fusional field, and have been monitoring him subsequently.

Harvey did a lifestyle makeover, stopped smoking, dropped a ton of weight, and has been doing very well overall in the ensuing years.  When I saw him on routine follow six weeks ago, I was a bit concerned when I dilated him and saw this Drance hemorrhage superiorly on his left disc.

Harvey 4-30 - Drance Heme

What made me a bit apprehensive was that this was his left eye, which had been so troublesome in the past.  He was totally asymptomatic and both his IOPs and threshold visual fields were pristine.  His blood pressure and blood sugar were both well under control.  We considered many etiologies, but a very likely possibility was the intense bout of spasmodic coughing that he experienced in the days prior to seeing me.  I decided to have him back in six weeks for follow-up, and here’s his left eye today:

Harvey 6-15Voila!  Self-resolution.  Easy solutions are always welcome, though the antennae never go fully down.


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