Case Presentation by Mike Antoniolli, MD
A 28-year-old male presents to the emergency department with complaints of 3 days of eye pain, photophobia, redness, and decreased vision. The pain has become so severe that he has had 2 episodes of emesis. He denies any fevers, chills, recent infections, or URI symptoms. He denies any inciting event, trauma to the eye, dust or foreign body exposure.
General: Patient is holding a hand over his left eye leaning forward. Appears uncomfortable
Eyes: Left eye reveals scleral injection, epiphora, photophobia, and blepharospasm in addition to the findings shown in the image below. A contact lens is noted in the unaffected eye. Pain/photophobia was only partially relieved with proparacaine.
1. What is the most likely outcome of this condition if he is not treated?
A. Corneal perforation
B. Intraocular hypertension
C. Dense cataract formation
D. Orbital compartment syndrome
E. Full blown AIDS
2. Given the patient’s corrective lens history, what is the most likely pathway that explains the above findings?
A. Bacterial keratitis->corneal ulceration->hypopyon
B. Caustic exposure->corneal abrasion->corneal liquefaction
C. Poor contact lens hygiene->bacterial keratitis->corneal abrasion
D. Rheumatologic illness->anterior uveitis->hypopyon
E. Childhood vaccinations->autism->ocular jenny mccarthitis
3. What additional finding would most likely be seen on slit-lamp examination of this patient?
A. Dendritic ulcerative lesions
B. Pingueculae and pterygia
C. Cell and flare in the anterior chamber
D. Very shallow anterior chamber and iridocorneal touch
Filed under: Senior Report