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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:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows multiple tiny corneal ulcers that were missed the day prior.
  2. What should you do next?  Have patient rinse out eye to make sure it is not just fluorescein clumping.  Consult ophtho.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. 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:

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