HISTORY OF PRESENT ILLNESS A 62-year-old female with no sig | Figure 1
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HISTORY OF PRESENT ILLNESS
A 62-year-old female with no significant medical history presented to the ED complaining of seeing "floaters" and flashing lights in her right eye associated with loss of vision in the right inferolateral visual field (affecting only her right eye) for the past three days. She did not wear eyeglasses or contact lenses, and denied pain, redness or discharge from the eye. She denied trauma to the eye or headaches.
PHYSICAL EXAMINATION
GENERAL APPEARANCE: The patient appeared well developed and in no acute discomfort.
VITAL SIGNS
- Temperature: 98.6◦F (37◦C)
- Pulse: 80 beats/minute
- Blood pressure: 135/85 mmHg
- Respirations: 20 breaths/minute
- Oxygen saturation: 100% on room air
Visual acuity:
- OD: 20/100
- OS: 20/20
- OU: 20/40
EYES: PERRL, EOMI and no afferent pupillary defect. Lids, lashes and lacrimal glands normal, no conjunctival or scleral injections, no ocular discharge. The cornea was clear, without edema, fluorescein uptake or cloudiness. No cell or flare on slit lamp examination. Right inferolateral visual field deficit affecting the right eye only. Retinal examination of both undilated eyes was normal. Intraocular pressures were 12 mmHg OD and 16 mmHg OS, respectively.
A linear, 10-MHz ultrasound probe was gently placed over the closed right eye using a small amount of water-soluble gel.
Diagnostic Questions
What is your DDX? What is the cardinal symptom to support this? Anything on the Ultrasound?