A healthy male in his 50s, reports several years of gradual onset painless deterioration in both central vision and visual fields OU. He was found to have elevated IOPs OU, with optic nerve cupping OU, and arcuate visual field defects OU. He was diagnosed with Glaucoma and treated with IOP lowering eye drops.
Several years later he continued to have worsening of vision OU despite optimal glaucoma treatment and was evaluated by Neuro-Ophthalmology.
He was found to have a massive 7 cm pituitary macroadenoma compressing his optic nerves OU!
Teaching point: There is no such thing as one size fits all in medicine, and there is seldom a slam dunk case!
Leave no stone unturned, until all known ignorance has be unveiled.
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