Diagnostic Quiz
Long-standing Burning
Has Patient Returning
Andrew S. Gurwood, O.D.
A 59-year-old white female presented with a chief complaint of burningand tearing for 7 months. The photo shows what she looked like. Her ocularhistory was unremarkable for diseases, significant cataract, injuries orsurgeries. Her systemic history was positive for hypothyroidism. She deniedany significant social history. No further historical data deserves mention.
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| A woman who complained of burning and tearing over 7 months came to theclinic with this appearance. Best-corrected visual acuity was 20/40 O.D.,20/30 O.S. |
How would you approach this case? Read on for further details about the visit. Then test your clinical skills by checking your diagnosis with the correct answer.
Best-corrected visual acuities were 20/40 O.D. and 20/30 O.S. at distanceand near. The external examination was normal with no evidence of afferentpupillary defect. There was no photophobia or pain on extraocular musclemovement. Refraction revealed myopia with astigmatism and presbyopia O.U.
Biomicroscopy demonstrated inferior corneal exposure, mild inferiorcorneal epitheliopathy and mild conjunctival injection. The internal anteriorsegment structures appeared normal. The angles were open by the Von Herrickestimation method O.U. Goldmann applanation pressures measured 18mm Hgin both eyes. The dilated fundus exam revealed normal optic nerves, posteriorpoles and peripheries.
Are there any additional tests you require? What is your diagnosis?What are your differential diagnoses? How would you manage this patient?
Check your answer.
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May 15, 2000