History of Present Illness: A 41-year-old man presents with pain and a foreign body sensation in the right eye since welding 4 days ago. The patient wore eye protective gear; however, he explains that he only wore sunglasses. A spark flew in from above his glasses and hit him in the right eye. The pain has been steady since. He complains of irritation exacerbated by blinking, but vision has remained unchanged. He has no other injury and no other physical complaint.
There is significant overlap among conditions that cause a red, painful, or red AND painful eye. Having trouble keeping them all straight? Need a refresher before heading in to see a patient with a new eye complaint? Check out our brief, practical ALiEM Cards on the topic:
- The Painful Eye (Author: Puja Gopal, MD)
- The Red Eye (Author: Michelle Lin, MD)
- Eye Differential Diagnoses (Author: Puja Gopal, MD)
Our latest ALiEM Card introduces the “Rule of 2’s,” a simple method that uses eye anatomy to help you recall some of the major ocular diagnoses! It builds a framework for your physical exam and will help you include or eliminate some of the more common ocular conditions.
The Rule of 2’s is easy to remember: 2 eyes, 2 major diagnoses to consider for each ocular layer, as you move anterior to posterior.
Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine residents. It was a particularly competitive year for Emergency Medicine, with 99.7% of first-year spots filled despite a whopping 2,047 positions being offered in 2017 (up by 152 spots compared to last year).1 Now begins the most crucial 3 or 4 years of your medical training that will prepare you for the rest of your career in Emergency Medicine.
You are caring for a patient with an incredibly swollen eye – like a scene out of almost any Rocky film. This patient is likely going to the CT scanner, but regardless of the finding (retrobulbar hematoma, orbital wall fracture, etc.) you still need to evaluate for extraocular muscle entrapment and loss of pupillary response. There’s only one problem: you can’t see the eye. The old standards like getting the patient to retract their lid using paperclips or a cotton swab may help, but sometimes there is just too much swelling, and those techniques are just not enough. Without brute force – and potentially causing more trauma – you likely won’t be able to examine this patient’s eye.
Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 76-year-old man presents with sudden-onset right-sided vision loss.