Additional History:
Three months ago, she went to student health services for worsening acne despite trying several treatments and was prescribed isotretinoin, which she now takes daily. Her only other medications include an oral contraceptive, ibuprofen as needed, and an albuterol inhaler, which she uses only a few times per year. Her family history is significant for migraines in her mother and sister.
Physical Exam:
Vitals: Temp: 36.8C, BP: 123/82, HR 68, RR 14, BMI: 31 kg/m2
Neuro exam:
VA with correction: 20/20 OU
Pupils: equal and reactive OU, no rAPD OU
EOM: full OU, no nystagmus
Confrontation Visual Fields (CVF): visual fields intact to finger count in all 4 quadrants of both eyes
Remainder of the neurological exam is within normal limits
External ocular exam:
Eyelids: flat OU, no ptosis OU
Conjunctiva: white and quiet OU
Cornea: Clear OU
Anterior Chamber: Formed OU
Iris: flat OU
Lens: clear OU
Intraocular pressures (IOP) by tonopen in ED: OD 15 mmHg, OS 13 mmHg
Fundoscopic exam of the right eye reveals the following (the left eye exam appears the same):
Above Image Credit: © 2020 American Academy of Ophthalmology
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