DIGITAL GRAND ROUNDS

Systemic Symptoms
Accompany Ocular Complaint

by Walt Mayo, O.D.

1. Slit lamp evaluation revealed conjunctival congestion, mucous discharge and lid edema O.D.

A 30 year-old Hispanic male presented with complaints of a red, swollen right eye and severe headaches that began 10 days previously. The patient also reported a recent history of fever, vomiting and dizziness. The patient did not speak English and a translator was not available, so we could not obtain any ocular or medical history.

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 going to http://www.optcom.com and clicking on "Digital Grand Rounds." It is Case No. 88 .

Best corrected visual acuities were hand movement at 5 feet in the right eye and 20/30 in the left eye. Biomicroscopy of the right eye revealed 4+ conjunctival congestion (figure 1), 2+ mucous discharge and 2+ lid edema. Exophthalmometry demonstrated a 5mm proptosis of the right eye.

2. Choroidal folds were evident in the inferior retina O.D.

A dilated fundus exam showed 4+ papilledema in the right eye with choroidal folds present in the inferior retina (figure 2). Extraocular motility evaluation in that eye revealed complete restriction in all fields of gaze.

B-scan ultrasound examination exhibited no apparent retrobulbar mass.

What is your diagnosis? 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.

Aaron Kerr, O.D., of Memphis, Tenn., provided this case.

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.

RK,CG

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