Ophtho On Call Case 7: Physical Exam

Ophtho On Call Case 7 Index

Physical Exam: 

General appearance: Anxious, diaphoretic male, sitting upright
Vitals: Temp: 37C, BP: 120/80, HR: 100, RR 18, 
Best Corrected Visual Acuity (BCVA): OD Hand motion OS 20/25
Pupils: OD hazvy view, OS round and reactive
EOM: OU full
Confrontation Visual Fields (CVF): OD unable, OS full
Intraocular pressures: OD 23 mmHg, OS 18 mmHg

External ocular exam:
Eyelids: OD matting of eyelashes with yellow discharge, OS flat
Conjunctiva: OD 3+conjunctival injection, OS white and quiet
Cornea: OD 1+stromal edema with haze, OS clear
Anterior Chamber: OD 4+cell and flare, 1 mm layered hypopyon inferiorly, OS deep and quiet
Iris: OD round, minimally reactive, OS round and reactive 
Lens: OD IOL with overlying fibrinous material, OS PCIOL

An external photograph of the right eye is shown below:  

endophthalmitis eyewiki

Above Image Credit

Dilated fundus exam:
Upon attempting dilated exam in the right eye, there s no view.
The left dilated fundus exam is WNL.

A B-scan of the right eye is performed and shown below:

vit heme jeanette du

Above Image Courtesy of Jeanette Du, MD

 OD showed hyperechoic vitreous debris. The retina is flat and attached 360 degrees. No evidence of retained lens fragment.

Given these findings, what’s at the top of your differential now?
Toxic anterior segment syndrome
Corneal ulcer
Postoperative Endophthalmitis
Endogenous Endophthalmitis
Rebound iritis
Retained lens fragment
Anterior uveitis

Click here to move on!

Ophtho On Call Case 7 Index
Ophtho On Call Case 7: Introduction
Ophtho On Call Case 7: Additional History