Case 8: Physical Exam

Case 8 Index

Physical Exam: 

Vitals: Temp: 37C, BP: 140/80, HR 82, RR 12
VA with correction: OD 20/200, OS 20/30 
Intraocular pressures (IOP) by tonopen: OD 52 mmHg, OS 13 mmHg
EOM: full
Confrontation Visual Fields (CVF): OD constricted 360, OS full  

Below is an image of what you see on external exam of the right eye:

Acute_Angle_Closure-glaucomaAbove Image Credit: CC BY-SA 3.0

In the right eye, there is conjunctival injection, corneal edema, a shallow anterior chamber, and a mid-dilated pupil.

External examination of the left eye is grossly within normal limits.

When flourescein is applied, there is no staining of the cornea in either eye.  

You attempt a fundoscopic exam of the right eye, but the view to the posterior pole is poor through the corneal edema.

Undilated fundoscopic examination of the left eye reveals a healthy optic nerve without disc edema or pallor and cup-to-disc ratio of 0.3. There are a few dot-blot hemorrhages and microaneurysms in the macula. The rest of the fundoscopic exam in this eye is within normal limits. 

What’s the most likely diagnosis? Choose 1 before moving on!
Corneal abrasion
Acute angle closure glaucoma
Cataract
Neovascular glaucoma
Diabetic retinopathy
Retinal detachment
Optic neuritis
Scleritis
Uveitis
Macular degeneration
Central retinal vein occlusion
Central retinal artery occlusion

You call an urgent ophthalmology consult.

 Click here for the ophtho exam!

Case 8 Index
Case 8 Introduction