DIGITAL GRAND ROUNDS

The Case of the Spontaneous 'Gushing'

by Walt Mayo, O.D.

A 27-year-old black male presented with a bizarre history of tears spontaneously "gushing" from an unknown source in his left eye. This had been going on for the past six weeks. He denied rubbing his eye or any history of trauma. He also denied any vision disturbances. He reported no other significant ocular, medical or family history.

This is the "cyst" that appeared in this patient's left eye.

How would you approach this case? Read on for further details about the visit. Then test your clinical skills by calling the Digital Grand Rounds phone line or by accessing our web page at www.optcom.com and clicking on "Digital Grand Rounds." It is Case No. 110.

Uncorrected acuities were 20/25 O.D. and 20/25-2 O.S. Minimal refractive error was found with just a slight amount of astigmatism, which when corrected gave solid 20/20 vision in both eyes.

Extraocular motilities were full and smooth with no restrictions. Pupils were normal in both eyes with no afferent pupil defect.

Intraocular pressures were 19mm Hg O.D. and 20mm Hg O.S. Dilated fundus examination was normal O.D. and O.S.

Anterior segment examination with biomicroscope was normal as well, with the exception of the large "cyst" in the  left eye (see photo) when the upper lid was retracted.

What is this condition and how would you manage this patient? Are there any additional tests that you would like to perform?

For answers, follow the instructions in the box below.

Dr. Mayo, a private practitioner in Georgetown, S.C., is technology director for the Southern Council of Optometrists. You may contact him at waltmayo@aol.com or waltmayo@sccoast.net.

TWO WAYS TO GET YOUR ANSWER

Check your diagnosis on our web site:
Using your web browser, access URL http://www.revoptom.com.
Click on "March Issue Highlights," then "Digital Grand Rounds."
Go to Case #110 to view "Digital Grand Rounds" online.

Check your diagnosis by phone:
Using a TouchTone telephone, dial (610) 964-4393.
After you hear the instructions, enter this month's code: 5
You'll hear a recorded message explaining the diagnosis, tests and management.

Cost of the call depends on long-distance rates from your area.