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Problem Solving

Problem Solving. Case 1. History. 22 years old female presents to ER physician with history of sudden redless decrease in vision in the rt. eye 10 days ago with mild headaches and pain on eye movement. Her past medical history is insignificant of any ophthalmic or systemic illness. Examination.

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Problem Solving

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  1. Problem Solving Case 1

  2. History • 22 years old female presents to ER physician with history of sudden redless decrease in vision in the rt. eye 10 days ago with mild headaches and pain on eye movement. Her past medical history is insignificant of any ophthalmic or systemic illness.

  3. Examination • On examination she showed the following Vitals: • Pulse:72/regular • Temp. 37 • Resp:14 • B.P 120/80

  4. Eye Examination • VA OD 20/100 OS 20/20 • Pain on abduction of Rt. eye • EOM: full • Red reflex: normal • Fundus ex.: normal disc, vessels, maculae

  5. Case Management • Summarize the case (+ve and -ve) • Any further information you needs to know in history? • Any further information you need to know in the examination • What is your provisional diagnosis? • What is your role as an ER physician in this case??? Who treats such a case • How does the ophthalmologist manage such a case?

  6. Case Summary

  7. Further History • Onset: how? When? What • Progression of vision, headaches, pain • Headaches Relieving & PPT factors • Uhthoff’s Phenomenon • Diplopia/ Oscillopsia /Dizziness • Parasthesia and weakness • Bowl symptoms

  8. Further History • Onset of Visual loss: How? When? What • Progression of vision, headaches, pain • Relieving & PPT factors • Social History • Smoking • Alcohol • Others • Family History • Drug History

  9. Further Examination • Proptosis • Ptosis • Tenderness over sinuses • Multiple pinhole • Pupil examination • Visual field

  10. Diseases Onset & Progress

  11. Provisional Diagnosis Optic Neuritis

  12. Differential Diagnosis Sudden discovery of chronic visual loss

  13. Differential Diagnosis • Other causes of Optic Neuropathies • Ischemia • Infections • Nutritional • Compressive • Hereditary • Traumatic

  14. Differential Diagnosis • Other causes of acute visual loss • Sinus disease • CRVO • CRAO • Retinal Detachment • Vitreous Hge.

  15. Why???

  16. Why???

  17. Why???

  18. Why???

  19. Differential Diagnosis • Other Causes of ON Disease • Sinus Disease • CRAO +CRVO • Retinal Detachment

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