Ophtho On Call Case 1: Introduction

History of Present Illness (HPI)

A 59 year old male with a past medical history significant for HTN, HLD, type- 2 diabetes mellitus, and past TIA presents to the emergency room with one day of left eye vision loss. He states he was helping his son fix his car’s engine one day ago when he realized he was making silly mistakes that he quickly attributed to no longer being able to see out of his left eye. Rest, squinting, or opening his eyes wider did not seem to improve vision. There is no associated pain at rest or with eye movements. He describes his vision as very limited and is at risk of bumping into things on his left side. He states eye still has vision when his left eye is covered and reports he sees well with his contacts typically. He denies any flashes of light or new floaters. He does not believe his left eye vision has gotten better or worse over the past day. He states he is compliant with medications. He states he normally has 20/20 vision, although he was told at his last eye exam about 1 year ago that he had signs of “macular degeneration.” He comes in now because he was concerned that his vision was not returning and is worried about maintaining his duties as a mechanic.

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What’s at the top of your differential diagnosis? Choose at least 3 before moving on!
Retinal Detachment
Non-arteritic ischemic optic neuropathy
Arteritic Ischemic Optic Neuropathy (Giant Cell Arteritis Associated)
Central Retinal Vein Occlusion
Central Retinal Artery Occlusion
Exudative (“Wet”) Macular Degeneration
Cataract
Acute Angle Closure Glaucoma
Vitreous Hemorrhage
Amaurosis Fugax

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