Case 8: Introduction

History of Present Illness (HPI)

A 65 year female with DMII and HTN presents to the emergency department complaining of severe eye pain and blurred vision in the right eye. She was watching TV this evening at home when the pain came on suddenly. She also complains of significant redness and notes haloes around lights. She denies discharge, flashes, or floaters and has never experienced anything like this before. The pain is a constant throbbing pain and was not relieved by acetaminophen. She states that at her last eye exam 9 months ago, she was told she had “mild diabetes in the eye” and cataracts. Her parents had cataracts as well, but there is no family history of glaucoma, macular degeneration, or vision loss. She wears contact lenses as she states she is “blind” without them, but was not wearing them today. 

As you are speaking with her she vomits in the trash receptacle next to her. 

The nurse hands you the patient’s list of medications and allergies which were confirmed prior to your meeting with the patient.

Tylenol prn 


What’s at the top of your differential diagnosis? Choose at least 3 before moving on!
Corneal ulcer
Corneal abrasion
Acute angle closure glaucoma
Neovascular glaucoma
Diabetic retinopathy
Retinal detachment
Optic Neuritis
Macular degeneration
Central retinal vein occlusion
Central retinal artery occlusion

Click here for the physical exam!