Headache behind left eye
UnFiNiShEd CaSe CoMe BaCk LaTeR
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History of Present Illness:
A man in his 30’s presents to the ED with 2 days of ongoing left ocular pain with associated headache. 2 days ago patient was seen by a local ophthalmologist and was diagnosed with dry eyes. Yesterday he was seen by your EM colleague and diagnosed with a migraine. Pain is worse with eye motion.
Denies any visual disturbance, blurry vision, double vision.
Patient wears corrective lenses at baseline.
Vital Signs & Physical Exam:
Vital signs are normal except for Physical exam is otherwise normal except for. IOP is 12 in each eye
Initial Differential Diagnosis:
- Dye clumping
- Corneal ulcer from contact
- Herpes keratitis
- Corneal abrasion
QUESTIONS:
- What does the case image show?
- What should you do next?
- Want a 1-minute consult/tutorial on this case?
- Want to know what happened with this patient?
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ANSWERS:
- What does the case image show? The image shows multiple tiny corneal ulcers that were missed the day prior.
- What should you do next? Have patient rinse out eye to make sure it is not just fluorescein clumping. Consult ophtho.
- Want a 1-minute consult/tutorial on this case? See yellow area from sample page below.
- Want to know what happened with this patient? See case conclusion below tutorial page.
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
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CASE CONCLUSION: We’ll just have to see
CASE LESSONS: