Ophtho On Call Case 4: Physical Exam

Case 4 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. There is a mild (1-2+) NS cataract.

Slit lamp 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
Phacomorphic glaucoma
Neovascular glaucoma
Secondary angle-closure glaucoma
Malignant glaucoma (aqueous misdirection syndrome)

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Case 4 Index
Ophtho On Call Case 4: Introduction