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55 year old machinist who complains of right eye pain for

the past 24 hours....
55 year old machinist who complains of right eye pain for the past 24 hours. He describes the pain as severe, aching, and deep, he has noticed a decline in his vision. he does not wear corrective lenses or protective eye wear at work. he denies any work related exposures. He denies any upper respiratory infection or allergies. He has a history of hypertension wich is well controlled with medication. He has no nausea, vomiting, diaphorseis, or abdominal pain. He smoked two packs of cigarettes daily for 40 years. His conjuntiva of the right ey is very erythematous. So what do you think is wrong with him? Can you give me 3 diagnoses? Lee
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Answered in 9 minutes by:
3/3/2013
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3,343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Verified
Doctor DanB : Hello and thanks for your question. In the context of this history, I suspect either a corneal abrasion (scratch)/infection, uveitis (iritis), or a severe conjunctivitis. How are you related to this peron?
Doctor DanB : Does this make sense?  Does this information help address your concerns? Do you have any other questions about this?   It appears as though you are not in the chat room currently.    I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.   If you would like to ask further questions or clarification regarding anything I've said, please let me know and I will be happy to address your concerns when I return to see if you've responded. If your concerns have been resolved... Your feedback is important to me and will help me improve my encounter with future customers.  Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated.  If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.  My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry! 
Customer:

So what do you think?

Customer:

I am in nurse practitioner school and have to give 3 diagnoses for this patients case study and could not figure it out

Doctor DanB : Just based on the case study, the most likely cause is uveitis.
Customer:

why do you think these are the diagnoses for this patinet?

Doctor DanB : Because a red, deeply painful eye with vision loss is most often uveitis, in a patient with no history of trauma or surgery.
Customer:

I thought this might have to do with the patient smoking history you dont think this is related?

Customer:

So what do you think about the smoking?

Doctor DanB : Next to no chance at all. I don't think it has any bearing on these symptoms.
Customer:

what do you think about the smoking do you think there is no relation to this problem?

Doctor DanB : I think smoking puts him at risk for several eye disorders but not these particular ones. I do not think smokimg is an issue with these symptoms, unless there's some other history you've not told me about.
Customer:

So what would be your first choice for this patient and then your second choice and your third choice please list them 1-3 and say why for each diagnosis. Thanks so much for all your help

Customer:

what do you think?

Doctor DanB :

1. Corneal foreign body causing a corneal abrasion and/or corneal ulcer (infection): deep, severe, and achy pain, associated with a red eye are signs of significant inflammation in the eye. The fact that he is a machinist not wearing protective eye wear at work put him the most at risk for this problem and therefore this would be the most common. The fact that the history says he denies any “work related exposures” is misleading because is very job as a machinist makes him a risk for a high-velocity metallic projectile penetrating his cornea and causing this or worse, such as an intraocular foreign-body causing endophthalmitis (overwhelming eye infection).

2. Uveitis: deep, severe, and achy pain, associated with a red eye are signs of significant inflammation in the eye and uveitis is the most common intraocular inflammation which can cause this. Most of the time, anterior uveitis does not cause significant vision loss, but a mild decline can be noticeable.

3. Conjunctivitis: deep, severe, and achy pain, associated with a red eye are signs of significant inflammation in the eye. Most cases of conjunctivitis do not get this severe causing vision loss and this severity of symptoms, though some fulminant cases can cause this. However, there was no note of discharge, so this is much less likely.

Customer:

thanks so much!

Doctor DanB :

My pleasure. Good luck.

Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy or unsatisfied.

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3,343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Verified
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