Reference no: EM133828050

CASE STUDY EYE DISORDER

Chief Complaint:
A 58 year old accountant presents to the clinic with a sudden onset of right eye pain and redness. Hebelieves something must have gotten in his eye while he was clearing brush in his backyardyesterday. No pain was noted during that time, but he awoke early this morning, and the painstarted within an hour. He wears contact lenses and has removed them without relief. He has nohistory of eye problems other than farsightedness, for which he has worn monovision contactlenses for 10 or more years. He has no known medical problems and considers himself "veryhealthy." He says the pain was horrible at first (10/10) and now is slightly less (8/10) but stillbad. He said although he removed his contacts and his vision is generally similar in both eyes,his vision in his right eye is very blurry.

Physical Examination
• Vital signs: T 98.4, BP 150/95, HR 88, RR 18, HT 70, WT 215 lbs.
• General: Patient holds right eye constantly during history and appears in distress.
• Vision: Visual acuity, uncorrected: OS 20/60; 0D less than 20/200. Eye movements brieflyassessed to be symmetrical. Pupillary responses-OS brisk and responsive; OD fails toconstrict although poor tolerance of exam.  Get your assignment done Now! OS normal structures, no lesions, redness,conjunctiva intact. OD eye is reddened and some watery tearing noted. No foreign bodyvisible. OS funduscopic exam within normal limits. OD funduscopic exam not tolerated.

Question 1. What are significant questions to ask in the history of a person complaining of eye pain?

Question 2. What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?

Question 3. What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?

Question 4. Would you refer this patient to a specialist? Which specialty? Why or why not?