On further questioning, he reports an episode of blacking out of his vision in the left eye, about one month ago, which lasted for a few minutes before resolving.
A review of his chart shows a recent Carotid doppler exam which showed a heterogeneous plaque and 65% stenosis of the proximal left internal carotid.
His medications include aspirin, metformin, glyburide, rosuvastatin, lisinopril, and metoprolol.
On review of family history, he shares that his father had an MI in his 60s and his mother suffered from a stroke in her 70s.
Vitals: Temp: 37C, BP: 142/85, HR 77, RR 18, BMI: 29.0 kg/m2
VA with correction: OD 20/30, OS Hand motions at 1 foot (cannot see big “E” on chart, can only see movement at 1 foot)
Pupils: reactive OU, 4+rAPD OS
Intraocular pressures (IOP) by tonopen in ED: OD 17 mmHg, OS 15 mmHg
EOM: full OU, no nystagmus
Confrontation Visual Fields (CVF): OD visual fields intact to finger count in all 4 quadrants of right eye, OS can perceive hand motion in all 4 quadrants of left eye
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: 2-3+nuclear sclerotic cataract OU
(for more information on cataracts, see 2020sim case 1)
Fundoscopic exam of the right eye appears within normal limits. On fundoscopic examination of the left eye, you see the following:
Above image credit: CC BY-SA 4.0
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Ophtho On Call Case 2 Index