Right eye pain

1. Right Eye Pain Case Study Analysis By

2. The Problem 55-year-old machinist who comes to the office complaining of pain to his right eye for the past 24 hours.

3. Known Facts about Mr. E Machinist 55 year old male Mild right eye discomfort for 24 hours Watery discharge No vision changes Does not wear corrective lenses No surgical history Denies work related exposures to eye injuries Denies seasonal allergies, nausea, vomiting, diaphoresis, abdominal pain History of hypertension managed by medication. 40 pack-year history of smoking Upper respiratory infection one week ago

4. Asking About the Eyes Do you wear goggles at work? Have you felt anything like sand or other irritant in your eye? Is the discomfort constant or intermittent? Can you describe the discomfort in more detail? Does it feel like pressure? Aching? Itching? Stinging? Does anything make it better? Worse?

5. Additional Subjective Data Cont’d Are you able to open and close your eye as usual? Any swelling? Is there any crusting of your eyelid? *Does the discharge you are experiencing have any color? Are you noticing any visual changes at all? If not decline... blurriness, flashing lights or dark spots, cooked or wavy items in visual field? Are you noticing any other symptoms such as congestion, headache, nausea, etc.?

6. What were you doing when you first noticed the discomfort, was the discomfort abrupt? Where were you? Have you ever felt anything like this before? If so, was it diagnosed? As what? Does anyone in your family or at work have similar symptoms? When was your last complete eye exam with an ophthalmologist? Were any problems noted at that time? Have there been any recent changes in your medications? Do you have any problems with fatigue, aching joints? Are you able to see colors and fine details? Is your peripheral vision affected ?

7. inspect the external eye and lids for color, drainage, swelling or ulcerations. test visual acuity assess eye muscle function palpate the nasolacrimal sac examine intraocular structures with an ophthalmoscope visualizing the conjuctiva , sclera, cornea, and iris Assess the pupils for PERRLA Assess the extraocular muscles for symmetry The Eyes Have It

8. Diagnostic Tests for the Eyes Slit lamp examination of the eye Culture suspicious or purulent discharge Corneal scraping and culture if indicated Corneal sensitivity testing Glaucoma examination Perform a Snellen test to assess visual acuity Cardinal positions of gaze

9. Possible Hypotheses, Actions, Recommendation, & Solutions Differential Diagnoses : Corneal injury from abrasion or embedded foreign body Entropion Iritis Keratitis

10. Corneal Foreign Body Treatment/Plan S urgical removal of foriegn body A ntibiotic drops and/or Ointments T opical cycloplegic for pain P ressure patch/bandage do not use patch if: there is a chance of perforation in the globe, if a corneal infiltrate is present, if there is a chance of retained intraocular foreign body dx . through eye exam

11. Entropion Treatment/Plan Tear and lubrication preparation Antibiotics Corticosteroids T each eye hygiene/care dx - physical examination of eyes and eyelids

12. Iritis Treatment/Plan eye drops to dilate pupil mild analgesics steroid eye drops if severe steroid injections dx - exam eye with a slip lamp shining light in unaffected eye will cause pain in affected eye glaucoma test- pressure will be lower in affected eye pupil will be smaller and irregular

13. Keratitis Treatment/Plan Antibacterial or Antifungal or Antiviral therapy (depending on cause) Artificial tears Steroid drops Surgical removal of foreign body if that is the cause If wearing contact lens advise to stop dx - vision exam careful inspection of corneas using slit lamp culture from surface of eye if infection is suspected

14. *Patient Education Needs* *Always wear appropriate eye protection when indicated at work * Smoking cessation