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Grand Rounds 119-
March 2009 |
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©Richard
Hom
CC: Red OD
HPI A 60 year old woman comes to me
with acute red eye for 3 days as well as headache on the left side
for the same amount of time. The patient was diagnosed in April
2008 with narrow angle glaucoma and was given a laser peripheral
iridotomy. She had been lost to follow up since April 2008.
Last night, the patient came to the emergency room with pain and
redness of the eye and was thought to have either an eye infection
or iritis. She was given topical antibiotic solution.
In the past, the patient was advised to take
two beta-blockers and a PGA for possible glaucoma, but she has not
taken that since 2007. She reports no allergies or intolerances to
medications.
OBJECTIVE: The patient sees 20/200
right eye and 20/20 left eye without lenses. There are no signs of
cells or flare in the right eye. The bulbar conjunctivae is
congested and hyperemic, 3/4 or 4/4. There is no signs of
mucopurulent discharge. The cornea has a Bowman's lever white swirl
patterned opacities with some negative staining. The left eye
has a white and clear sclera and no anterior chamber reaction.
However there are vesicles on the cheek. While pressing the left
side of the head, there appeared to be some tenderness. argins.
Questions: Is it...
(1) Conjunctivitis, NOS
(2) Dry Eye Syndrome or Keratoconjunctivitis Sicca?
(3) Episcleritis/Scleritis?
(4) Other?
©Richard
Hom
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