Ophthalmology Case Study: Right Eye Pain
- siricnikku
- 11 minutes ago
- 2 min read
A 51-year-old woman presents to the ED with intense right brow, right cheek, and right eye pain/pressure for the past 2-3 hours. She also mentioned having blurry vision and rainbow-colored halos around lights. She also has nausea and has vomited twice since experiencing the eye pain. Regarding her ocular history, the patient started wearing reading glasses when she was 42 and currently wears progressive bifocals with hyperopic correction for the multiple corrections she needs. Her past medical history includes a degenerative disk disease in her lower back, and her family history involves her father having chronic angle closure glaucoma. Her oculus dexter (OD-right eye) pupil is slightly dilated with a slowed response to light. Her oculus sinister (OR- left eye) is round and reactive to light. Her anterior chamber angles are also reported to be more shallow than normal. Her inner eye pressure (intraocular pressure) is also reported to be higher than usual.
In terms of treatment, a surgical peripheral iridectomy (placing a hole in the peripheral iris) was performed on the patient. This procedure restores aqueous flow from the posterior to the anterior chamber by creating an extra opening in the iris, restoring normal aqueous humor drainage. This procedure is often curative of the affected eye. In the unaffected eye, prophylactic peripheral iridectomy was conducted to prevent an episode in that eye as well. Having an episode of this condition makes patients more likely to have another episode in their eyes.
Possible Diagnoses:
Acute Angle Closure Glaucoma presents with severe ocular pain, headache, blurred vision, halos around lights, nausea, and vomiting. Typical eye exam findings include mild conjunctival injection, hazy cornea, mid-dilated pupil, shallow angle, and elevated intraocular pressure. Surgery is one of the most common ways to treat this condition.
Primary Open Angle Glaucoma presents with eye drainage blockage as the drainage channels are open but do not drain fluid properly. Findings for this include increasing inner eye pressure (intraocular pressure, or IOP). This is one of the most common types of glaucoma and often presents with no symptoms. When caught early, it responds readily to medication.
Normal Tension Glaucoma is when the optic nerve is damaged even though the eye pressure is within a normal range. This can be due to abnormalities in the blood flow to the optic nerve and structural weakness of the optic nerve tissue. Eye pressure medication is usually recommended for treatment, and eye pressure is monitored at subsequent eye check-ups.
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Thank you for reading,
Siri Nikku
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