Case 6: 2 years later…

Case 6 Index

History of Present Illness (HPI)

A 58 year old male with a 5 year history of poorly controlled T2DM complicated by peripheral neuropathy and claudication, non-obstructive CAD, obesity, HLD, NAFLD, CKD3, OSA, and bilateral knee OA presents with 2 days of severe right eye pain, periocular headache, and vision loss. He denies trauma, flashes, floaters, or discharge. Of note, the patient says he wore colored contacts a few nights ago and fell asleep in them. He removed them the next morning when he woke up and has not worn them since. He has tried tylenol and advil for the pain without relief. His last eye exam was 2 years ago at which time he reports receiving “eye injections” for his diabetes.

Which of the following are highest on the differential diagnosis? HINT: Think about which entities cause PAIN. Choose at least one before continuing!
Non-proliferative diabetic retinopathy
Proliferative diabetic retinopathy
Retinal detachment
Central retinal artery occlusion
Vitreous hemorrhage
Central retinal vein occlusion
Acute angle closure glaucoma
Neovascular glaucoma
Corneal ulcer
Herpetic keratitis

Click here for the physical exam!

Case 6 Index

Case 6: Introduction
Case 6: Physical Exam
Case 6: Ophtho visit