Ophtho On Call Case 1: Physical Exam

Ophtho On Call Case 1 Index


rAPD Check – Checking for an rAPD is important rule out any neurological etiology for this visual disturbance. Dilation in both eyes will preclude the ability to check pupillary response, so it must be checked prior to dilation. 

IOP and AC Depth Check – High eye pressure can be worsened with dilation depending on the mechanism of the patient’s elevated pressure. With high pressure you should gonio the patient or at the very least, check the anterior chamber of the patient by Van Herrick’s to check for a narrow angle which could be completely occluded with dilation. 

Physical Exam:

VA with correction: OD 20/25, OS 20/20  
Pupils: reactive OU 
Intraocular pressures (IOP) by tonopen in ED: 10 mmHg OU
EOM: full OU
Confrontation Visual Fields (CVF): OD restricted inferiorly, OS intact to finger count in all 4 quadrants 

External ocular exam:
Eyelids: flat OU 
Conjunctiva: white and quiet OU
Cornea: Clear OU
Anterior Chamber: Deep and quiet, no cells or flare OU
Iris: flat OU
Lens: Clear OU

Based on the above findings, you feel safe dilating the patient and instill the dilating drops. B-scan is an important test to perform in this patient, but is not affected by dilation. You can now perform this test, while you’re waiting for the patient to dilate.

Dilated fundus exam shows the following:

B-scan shows the following:

Peripheral fundus exam reveals the following:

What’s the most likely diagnosis?
Ocular migraine
Posterior scleritis
Rhegmatogenous retinal detachment
Tractional retinal detachment
Choroidal detachment
Exudative retinal detachment

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Ophtho On Call Case 1 Index

Ophtho On Call Case 1: Introduction
Ophtho On Call Case 1: Additional History