Ophtho On Call Case 8: Additional History & Physical Exam

Ophtho On Call Case 8 Index

Additional History: 

Upon further questioning, the patient reports difficulty remembering to take her anti-hypertensive medications. She also reports a history of exertional chest pain upon various physical activities such as climbing stairs too quickly. Chart review reveals she has been diagnosed with peripheral vascular disease for which she takes cilostazol. Family history reveals a mother with a history of STEMI at 52 and sister with hypertension.  

Physical Exam: 

General appearance: Woman in no apparent distress, appears her stated age 
Vitals: Temp: 37C, BP: 164/92, HR: 92, RR 16
Best Corrected Visual Acuity (BCVA): OD 20/40, OS Count fingers at 2 feet
Pupils: Pupils equal and reactive to light OU, 1+rAPD OS
EOM: full OU 

Confrontation Visual Fields (CVF): Full OU
Intraocular pressures (Tonopen in ED): OD 17 mmHg, OS mmHg

External ocular exam:
Eyelids: OU flat
Conjunctiva: OU white and quet
Cornea: OU Clear
Anterior Chamber: OU deep and quiet
Iris: OU round and reactive, no neovascularization of the iris (NVI) OU
Lens: 1-2+nuclear sclerosis OU

Gonioscopy: OU open to scleral spur, no NVI/NVA

Dilated fundus exam:
The right dilated fundus exam is WNL. Dilated fundus exam of the left eye reveals the following:

CRVO Jeanette Du

Above Image Courtesy of Jeanette Du, MD

What’s at the top of your differential now?
Central retinal vein occlusion
Central retinal artery occlusion
Ischemic optic neuropathy
Diabetic retinopathy
Branch retinal vein occlusion
Branch retinal artery occlusion

What imaging would you want to obtain?
Flourescein angiography
OCT macula


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Ophtho On Call Case 8 Index
Ophtho On Call Case 8: Introduction