Case 3: Physical Exam

Case 3 Index

The correct answer is flashes. Whenever a patient has floaters, the presence or absence of associated flashes (or photopsia) should be elicited. Presence of flashes should raise level of concern.

Our patient denies any flashes. 

Physical Exam:

VA with correction (glasses on): 20/30 in both eyes
EOM: full
Confrontation visual fields (CVF): full OU
Pupils: PERLLA
External Exam: lids within normal limits, conjunctiva white and quiet, cornea clear, anterior chamber formed, iris flat bilaterally

On fundoscopic exam of the right eye with the panoptic you see this:

What’s at the top of your differential diagnosis? Choose 3 before moving on!
Nearsightedness (myopia)
Diabetic retinopathy
Retinal detachment
Vitreous detachment
Hypertensive retinopathy
Optic neuritis
Ocular migraine
Macular degeneration

Given the new onset of these symptoms, you recommend ophthalmology evaluation soon and are able to get your patient an appointment with a colleague later that week. 

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