Eye Disorders

Question 1

A 65 year-old male presents with blurry vision, photosensitivity and pain in the left eye. The conjunctiva is injected, there is a watery discharge in the left eye, and there is a vesicular rash above the left eye and along the forehead that does not cross the midline. The right eye appears normal. What is the most likely diagnosis?

Answer 1

Herpes Zoster Ophthalmicus

Question 2

A patient presents with foreign body sensation, blurred vision, eye redness, and photosensitivity. On exam, you note a dendritic lesion on the cornea. What is the most likely diagnosis?

Answer 2

Herpes Simplex Keratitis

Question 3

A patient presents with unilateral eye pain and blurred vision after being punched in the face. On exam, you note blood pooling in the anterior chamber. What is the most likely diagnosis?

Answer 3

Hyphema

Question 4

A patient presents with itching, burning, and redness in both eyes. On exam, you note scaly eyelids and a yellow crust in the eyelashes. What is the most likely diagnosis?

Answer 4

Blepharitis

Question 5

A 30 year-old female presents with severe unilateral eye pain, blurred vision, photophobia, and foreign body sensation. She reports being “poked in the eye” by her infant daughter this morning. You apply anesthetic eyedrops in order to examine the eye, and the patient reports complete pain relief. What is the most likely diagnosis?

Answer 5

Corneal abrasion

Question 6

A 9 year-old male presents with rhinorrhea, congestion, eye itching and burning, and mucopurulent discharge. He states that it was difficult to open his eyes when he woke this morning because they were “stuck”. On exam, you note injected conjunctiva and preauricular lymphadenopathy. What is the most likely diagnosis?

Answer 6

Viral Conjunctivitis

Question 7

A 68 year-old female presents with frank blood in the left eye that completely obscures the sclera. She denies pain, itching, burning, photophobia, and loss of vision. What is the most likely diagnosis?

Answer 7

Subconjunctival hemorrhage

Question 8

A 48 year-old female presents with severe eye pain and photosensitivity without itching or discharge. What in the past medical history would most support a diagnosis of scleritis?

Answer 8

Systemic inflammatory autoimmune disease, such as RA or lupus

Question 9

A patient presents with acutely onset headache, nausea, vomiting, and blurred vision. On exam, you note that the eye is red and the pupil is non-reactive. Tonometry indicates a pressure of 65 mmHg. What is the most likely diagnosis?

Answer 9

Angle-closure glaucoma

Question 10

A patient presents with tenderness in the upper orbit. On exam, you note that the lateral portion of the upper eyelid is swollen over the lacrimal gland. What is the most likely diagnosis?

Answer 10

Dacryadenitis

Question 11

A patient was struck in the eye during a fist fight, and now complains of diplopia. On exam, you note hypoglobus and enophthalmos. What is the most likely diagnosis?

Answer 11

Orbital blowout fracture

Question 12

What are the indications for surgical management of orbital blowout fracture?

Answer 12

Muscle entrapment, unresolved diplopia, large fracture, displaced globe

Question 13

An elderly patient presents with chronic vision loss. On exam, you note a cloudy lens. What is the most likely diagnosis?

Answer 13

Cataract

Question 14

A patient presents with swelling to the lower left eyelid. The swelling seems to be associated with the tarsal plate, and the eye exam is normal. What is the most likely diagnosis, and which structure is affected?

Answer 14

Chalazion, meibomian gland

Question 15

A pediatric patient presents with reduced visual acuity. On exam, you note misalignment and an abnormal cover/uncover test. What is the most likely diagnosis?

Answer 15

Strabismus

Question 16

A patient with a history of RA presents with eye pain, redness, and photophobia, but denies foreign body sensation. On exam, you note a poorly reactive pupil, and a white substance floating in the aqueous humor. What is the most likely diagnosis, and how would you expect the pain to respond to topical anesthetics?

Answer 16

Iritis/uveitis

No relief with anesthetics

Question 17

A patient presents with acute unilateral vision loss. He describes a curtain across his field of vision. What is the most likely diagnosis?

Answer 17

Retinal detachment

Question 18

A patient presents with acute vision loss. He has a history of HTN and DVT. On fundoscopic exam, you note venous tortuosity and dilation, intraretinal hemorrhages and disc edema. What is the most likely diagnosis?

Answer 18

Central retinal vein occlusion

Question 19

You are examining a patient with a history of poorly controlled DM who reports a slow, steady decline in his vision without associated eye pain. Fundoscopy reveals a number of microaneurysms and several blot hemorrhages. What is the most likely diagnosis?

Answer 19

Diabetic retinopathy

Question 20

A patient who was recently diagnosed with a brain tumor presents to you for an eye exam. You notice that the optic nerve appears swollen and raised. This is most likely a form of optic ______ called ______.

Answer 20

neuritis, papilledema

Question 21

A patient presents to you complaining of dizziness. While evaluating EOMs, you notice an uncontrolled, repetitive movement of the eye. What is the correct term to describe this finding?

Answer 21

Nystagmus

Question 22

A patient presents with unilateral exophthalmos, blurry vision, diplopia, fever, and pain with eye movement. The patient also reports a recent history of sinus infection. What is the most likely diagnosis?

Answer 22

Orbital cellulitis

Question 23

What diagnostic and therapeutic procedures are indicated for the previous patient?

Answer 23

Emergent CT
IV antibiotics
Surgical drainage

Question 24

A 32 year-old female patient presents with ocular pain, especially with eye motion, and blurry vision. Fundal exam shows some disc swelling but is otherwise unremarkable. What is the most likely diagnosis?

Answer 24

Optic neuritis

Question 25

What is the appropriate treatment for the previous patient?

Answer 25

High-dose steroids

Question 26

Based on her current condition, the previous patient is at risk for developing which disease in the future?

Answer 26

Multiple sclerosis

Question 27

A patient presents with localized swelling of the lower eyelid that is tender. The swelling appears to emanate from the base of an eyelash. What is the most likely diagnosis?

Answer 27

Hordeolum

Question 28

An elderly patient presents with a gradual, painless decline in vision. On exam, you note drusen over the macula. What is the most likely diagnosis?

Answer 28

Age-related macular degeneration (dry)

Question 29

If the previous patient’s condition is not addressed, what might the disease progress to?

Answer 29

Wet macular degeneration with neovascularization

Question 30

A patient presents with eye irritation. On exam, you note that the lower lid is turned inward. What is the most likely diagnosis?

Answer 30

Entropion

Question 31

Under which circumstances might you recommend surgical correction of the previous patient’s condition?

Answer 31

If the lashes are touching the cornea

Question 32

A patient presents with eye pain, redness, discharge, and photophobia. On exam, you note that the cornea is opaque. The patient is a contact lens wearer. Which condition is the most concerning diagnosis for this patient?

Answer 32

Corneal ulcer

Question 33

The bacteria most likely responsible for the previous patient’s infection is ______, and must be treated with higher than normal doses of ______ antibiotics.

Answer 33

pseudomonas, fluroquinolone

Question 34

A patient presents with eye dryness and excessive tearing. On exam, you note that the upper lid is turned outward. What is the most likely diagnosis?

Answer 34

Ectropion

Question 35

A patient presents with itching, burning, redness, and pain in the left eye. On exam, you note a yellow/white discharge. No preauricular lymphadenopathy is present. What is the most likely diagnosis?

Answer 35

Bacterial conjunctivitis

Question 36

A patient presents with eye pain and foreign body sensation. He admits to drilling through metal several days ago without safety glasses. What is the most likely diagnosis?

Answer 36

Corneal foreign body

Question 37

While examining a patient, you note a fibrous tissue extending from the conjunctiva to the sclera. The patient reports no pain or vision problems. What is the best description for this finding?

Answer 37

Pterygium