Ocular Problems Case Study: Essay Sample on Diagnosis and Management

Relevant History and Symptoms

Andreas is in his mid-thirties and has been having ocular problems. Since the last slight test, which was conducted more than a year past, he has red-eye that is the reason for the visit. The patient explains that he is not experiencing any headaches; neither does he have flashes/floaters. Also, the doctor has noticed that the patient’s vision had not been impaired. The patient generally has no allergy to claim that he is sick, and is also a precautionary reason. The patient has had no ocular injuries or mistakes in the eye. Moreover, the patient’s family history indicates that the patient’s family has no ocular problems.

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Upon examination by the doctor, the patient’s right eye’s unaided vision was on 4/6. The left one was on 5/6, which was an indication that the vision of the patient, on both eyes, was less efficient than the average person. The refraction improved when the patient had spectacles on making his vision similar to that of an average person. The Anterior eye exam was also conducted by the doctor, and all but the conjunctiva gave positive results without an indication of problematic defect. The results for the right conjunctiva were white, while the left conjunctiva was red. The left and right funduscopic tests also showed some excellent results for the patient, and which indicated that there was no severe harm to which the patient was exposed (Stanford Medicine 2020). The macula on both eyes was clear, and the peripheries of both eyes were ordinary. The vessels were also of excellent calibre, as well.

This history and symptoms are essential in the analysis and breakdown of the ocular problem that the patient is going through. This paper looks at the conditions keenly, including the necessary differential diagnoses and patient management decisions that should be adopted.

Examinations Conducted

The examinations conducted to determine the problem with Andreas’ eye were the Anterior Eye Examination and the Funduscopic Examination. The Anterior Eye Examination checks for glaucoma and cataracts (American Academy of Ophthalmology 2020). It inspects the Cornea of the eye, the iris, and lens. It applies the tangential light to the Cornea and assesses whether the patient’s iris is entirely visible without a shadow. There are two possible results of the anterior eye examination: normal and abnormal (American Academy of Ophthalmology 2020). The eye is considered normal when the Cornea is translucent, avascular and smooth; the anterior chamber has aqueous humour and is clear; the iris is flat and has a variety of colors; the pupil is located at the center of the iris; the eye lens is transparent and of uniform density; upon visualization with a tangential light, there is no shadow of the iris that is cast.

On the other hand, the findings are abnormal if the Cornea has ulcerations, scars, shows arcus senilis (an arc that can be seen above and below the exterior part of the Cornea that covers over the anterior of the eye, which may eventually become a complete ring around the iris of the eye), and/or pterygium (benign growth of the conjunctiva). Another abnormality is where the iris has an inflammation (a condition known as iritis) (American Academy of Ophthalmology 2020). Also, cataracts, dislocation of the lens, and aphakia (absence of the eye lens) are abnormal results in the anterior eye examination.

The next examination that was conducted by the doctor was the funduscopic examination of the eye. The funduscopic exam is a routine procedure that every doctor’s examination and is not a preserve of the ophthalmologists. It is exclusively an inspection where the patient looks through the ophthalmoscope, which illuminates the retina through the regular iris defect (Stanford Medicine 2020). Light rays making the spitting image of the retina recur via the pupil. The viewing window of the ophthalmoscope comprises a lens that adjusts light rays to help the patient. In the method, the patient looks at features that are lying in the deepest part of the ball, jointly referred to as the eye grounds (retina, retinal blood vessels, optic nerve head [disk], and to some extent, subjacent choroid). The pupil is customarily widened using pharmacological methods to make the retinal check easier, and for analysis of the macula (Stanford Medicine 2020). One weakens the pupilloconstrictor muscle of the iris with a non-absorbable, temporary topical par sympatholytic drugs, leading to a larger pupillary aperture (Stanford Medicine 2020). Compared to the ophthalmologist, the internist, neurologist, or paediatrician focuses mainly on funduscopic indicators of widespread disease and less on local ocular disease.

The funduscopic examination provides a lot of meaningful information concerning a medical diagnosis, including high blood pressure, diabetes, and an increase in pressure on the brain as well as infections like endocarditis (Stanford Medicine 2020). Therefore, owing to the vast array of maladies or medical conditions shown by the funduscopic examination, most physicians are partial to the examination, as it checks the box of medical suitability.

The results that would show a normal fundus shows that the disk has a sharp margin and of a standard colour with a minute central cup. The arterioles and venules have standard colour, course, and sheen. The macula is also enclosed by an arching temporal vessel, or vessels.

Differential Diagnosis

Differential diagnosis lists all the possible conditions or maladies that could be responsible for the symptoms that the patient was experiencing at the time of the medical visit. In the case study, the red-eye is a sign of ocular inflammation, which is usually a benign condition manageable by primary care or general physicians. The most common reason for the red-eye is Conjunctivitis (Mocan and Azar 2005). Other known reasons include blepharitis, corneal abrasion, an antigen/allergen, subconjunctival bleeding, keratitis, glaucoma, scleritis, iritis, and chemical burn (Mocan and Azar 2005). The differential diagnosis of the red-eye is quite comprehensive that the care provider must be done after the caregiver has distinguished between the different possible diagnoses. Misdiagnosis is a substantial medicolegal pitfall because the condition that may cause the red-eye could have a significant vision-threatening sequence of the disease (Mocan and Azar 2005).

Management Decisions

The reason for red-eye can be detected by a comprehensive patient background and careful eye scrutiny. Management is founded on the causal etiology (WebMD 2020). Distinguishing the need for any recommendation of an ophthalmologist is essential in the primary care treatment of the red-eye. The management of the scratched cornea would take a systematic approach so that the scratch heals within a good time frame. Most abrasions are minor and heal on their own within a few days. However, the patient must still see a doctor. The abrasion may be treated using an antibiotic eye drop or an ointment. It would also be prudent to prescribe steroid eye drops that would help with the inflammation and lessen the chances of the scratch turning into a scar. In addition to the prescriptions, I would also prescribe lubricating eye drops that will ease the discomfort.

The referral to a more specialized practitioner is needed when severe pain persists even after the application of anaesthetics; when the patient needs topical steroids; or the patient begins to have a loss of vision, discharge copious purulent when the patient has a traumatic eye injury, or there was a recent ocular surgery.

The options available for the patient’s referral and follow-up include ophthalmologist, the internist, or the neurologist. All these are relevant practitioners to whom the patient can be referred because the red-eye might be a sign of many other maladies than just the ones identified in the differential diagnosis (Ramachandra et al. 2019). The red eye may be a sign of hypertension, and the internist and neurologists could find this an area of interest to them. Bloodshot eyes could be an indication of hypertension since high blood pressure can damage the blood vessels that transport the blood to one’s retina, which is the part of the eye that is sensitive to light. Such is known as hypertensive retinopathy.

Discussion

The primary reason for the patient’s visit is the red-eye that has persisted since the last check-up that he had. The test results from the patient’s sheet indicate that upon the anterior eye examination, the patient’s eyelids and lashes on both sides were transparent. The conjunctiva of the right eye was white, but that of the left was red. The Cornea of both the right and left eye had a 360 arcus. The patient showed a good quality of tears from both the right and left eyes. His lenses were clear on both right and left eyes as well as clear vitreous on both left and right eyes. The funduscopic examination exams indicated that the patient had clear macula on both the right and left eye; usual peripheries on both right and left eyes; functional caliber blood vessels on both the right and left eyes; and CD values of 0.40 and 0.35 on the right and left eye, respectively.

The inflammation of the left conjunctiva is the main feature of focus in the medication and management of the patient’s condition. The patient’s red-eye cannot be classified as a minor irritation given it has lasted for a considerably long time. The bloodshot eyes could only then indicate that the patient has a serious if not mild medical condition. The patient’s intraocular pressure also varies on the left eye and is higher on the left than it is on the right. The intraocular pressure, however, is not as high to rule the case as an indication of glaucoma because it is below the pressure level for glaucoma.

Furthermore, the patient’s vision is not impaired. It has no headache, neither does he have a previous ocular injury or infection. The patient’s family also has no ocular problem that is known.

The case of the patient’s corneal scratch can thus be concluded to be less dangerous but one that can be managed efficiently by the first aid before referral to a specialized practitioner. Usually, a scratched cornea can heal on its own when the right medication is applied, and when the patient has the right prescription (Hellem 2016). The management of the scratched cornea would take a systematic approach so that the scratch heals within a good time frame. Most abrasions are minor and heal on their own within a few days. However, the patient must still see a doctor. The abrasion may be treated using an antibiotic eye drop or an ointment. It would also be prudent to prescribe steroid eye drops that would help with the inflammation and lessen the chances of the scratch turning into a scar. In addition to the prescriptions, I would also prescribe lubricating eye drops that will ease the discomfort. Moreover, covering the eye or taping it would be essential because the eye could be susceptible to light, which may make the condition to be worse when it bothers the eye of the patient (Hellem 2016). If such simple therapeutic drills are observed, the patient’s eye should heal from the abrasion within three to four days.

Also, the patient ought to be advised on the necessary drills that they must take when they have had the scratch. Firstly, they should rinse their eyes using saline solutions or clean water to flush the foreign object from the eye. Secondly, one should blink to get rid of the small bits of the foreign. Thirdly, the patient should pull their upper eyelid over the lower eyelid so that the eye lashes on the lower eyelid can brush away any foreign particles caught underneath the upper eyelid.