history:A 64-year old Thai woman with irritating symptom OD for one month
She suffered from irritation & tearing in her right eye for one month. Neither redness or discharge found.
1. Chronic hepatitis B : loss F/U for 1 year
2. DM type 2 : well controlled, diagnosis at 2 months ago
3. Rheumatoid arthritis with history of chloroquine-induced maculopathy 20 years ago
6/18 c ph 6/9
6/9 c ph same
What should be exam further?
What is the differential diagnosis? What should be done?
Do you see something abnormal in this picture?
Note the slit-like lower punctum. This patient undergone multiple DCR and punctoplasty procedures 20 years ago.