Answer: It’s important to perform flourescein staining and examination of the cornea under cobalt blue light. Flourescein staining is particularly important given the history of sleeping in contact lenses. A corneal abrasion or ulcer needs to be ruled out and flourescein will highlight areas of corneal epithelial defects. Both of these corneal injuries can be extremely painful. Below is an example of a corneal abrasion stained with flourescein both with and without cobalt blue light.
Herpetic keratitis can also present with red eye and decreased vision and fluorescein would highlight a dendrite. This is an example of a herpetic dendrite illuminated by fluorescein under cobalt blue light.
Back to our patient…
Flourescein staining of our patient’s cornea is within normal limits (no staining, no abrasion, ulcer, or dendrite).
On fundoscopic exam with the panoptic, you see this:
You also notice on palpation of the eyes, with the eyelids closed, that the right eye feels extremely firm.
Here’s one more consideration before we narrow the differential:
Considering these factors, it’s time to hone in on a diagnosis.
Click here to move on!
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