Eye Pain in a Woman With Multiple Health Conditions

Byung Josh Kim, OD; Case Series Editor: Jean Marie Pagani, OD


March 24, 2014

Clinical Presentation

A 58-year-old woman comes to the emergency department because of pain in her right eye that has lasted for the past 2 days. She reports a painful red right eye but denies any discharge, itchiness, or burning. She also reports frontal headaches on the right side. She describes the pain as a 7 out of a possible 10.

Her systemic health is remarkable for hypertension, a history of asthma, allergic rhinitis, rheumatoid arthritis, sarcoidosis, and a history of pulmonary embolism. All current health conditions are stable and monitored by her primary healthcare provider.

Examination findings include the following:

  • Best-corrected visual acuity: 20/20 OD, 20/25 OS

  • Extraocular movements: Full and smooth OU

  • Pupils: Equal, round, reactive to light, with no afferent pupillary defect OU

  • Confrontation fields: Full to finger count OU

  • Goldmann applanation tonometry: 9 mm Hg OD, 9 mm Hg OS

A dilated fundus examination revealed the following:

  • 0.55 × 0.55 cup-to-disk ratios with pink, healthy, distinct neuroretinal rims in both eyes

  • Posterior fundus grounds were normal.

  • Peripheral fundus revealed no retinal holes, tears, or detachments in both eyes.

Slit-lamp examination revealed the following:

  • OS: All anterior structures were normal.

  • OD: See Figure

Figure. Grade 3+ diffuse injection in the bulbar conjunctiva, grade 2 injection in the palpebral conjunctiva; (-) papillae, follicles, and anterior chamber reaction.

All other anterior structures are normal.


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