CASE STUDY EYE DISORDER
Chief Complaint:
A 58 year old accountant presents to the clinic with a sudden onset of right eye pain and redness. He believes something must have gotten in his eye while he was clearing brush in his backyard yesterday. No pain was noted during that time, but he awoke early this morning, and the pain started within an hour. He wears contact lenses and has removed them without relief. He has no history of eye problems other than farsightedness, for which he has worn monovision contact lenses for 10 or more years. He has no known medical problems and considers himself “very healthy.” He says the pain was horrible at first (10/10) and now is slightly less (8/10) but still bad. He said although he removed his contacts and his vision is generally similar in both eyes, his vision in his right eye is very blurry.
Physical Examination
• Vital signs: T 98.4, BP 150/95, HR 88, RR 18, HT 70, WT 215 lbs.
• General: Patient holds right eye constantly during history and appears in distress.
• Vision: Visual acuity, uncorrected: OS 20/60; 0D less than 20/200. Eye movements briefly assessed to be symmetrical. Pupillary responses—OS brisk and responsive; OD fails to constrict although poor tolerance of exam. OS normal structures, no lesions, redness, conjunctiva intact. OD eye is reddened and some watery tearing noted. No foreign body visible. OS funduscopic exam within normal limits. OD funduscopic exam not tolerated.
Questions
1. What are significant questions to ask in the history of a person complaining of eye pain?
2. What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?
3. What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?
4. Would you refer this patient to a specialist? Which specialty? Why or why not?
