Problem Solving

Instructions

•Analysis of every phrase

•Take care of every word

•Every word has a significance

•Don’t rush to the final diagnosis

•Write in a step wise approach

Examples

Case 1

•Female patient aged 46 years old complaining of right rapid deterioration of vision since yesterday with pain, photophobia, lacrimation and headache.

•A. What is the differential diagnosis of the case ?

•Examination of this case revealed: right eye VA: 1/60, ciliary injection, corneal edema, shallow anterior chamber, with dilated oval pupil. Fundus coul not be examined due to hazy media.

•Left eye VA: 6/9 with +4 glasses, shallow AC

•B. Comment on final diagnosis and how to manage such case

Case 2

•Male pat. Farmer, aged 6oys came to complain of diminution of vision (fogy vision) of both eyes, more in the right eye.

•Gradual, progressive, painless since 6 months in the right eye and recently in the left eye.

•It is more in the day light.

•No treatment received before.

•On examination:

•VA: OD 3/60. OS 6/36 not corrected

•Anterior segment was normal, pupil was regular and reactive, greyish coloration of the pupillary area with presence of iris shadow in both eyes, IOP was normal, fundus was normal

•Comment on the case

•Age: senile problem

•C / O ………...DD

•Exclusion of other pathologies

•Final diagnosis

•Investigation

•Management

Case 3

•A baby

•Aged 4 months

•Came with his parents; to complain of :

•The color of his pupil looks abnormal

•he cannot fix any object or know his mother

•No other data

•Comment

•Congenital anomaly

•DD leucocorea

•Examination under anesthesia

•Investigation

Case 4

•Male patient 50 years old

•Co/ Left red eye , pain photophopia , lacrimation& diminution of vision .

•Past History

• Diabetes millitus

•Chronic inflammation of left lacrimal sac

•Comment

Case 5

•50 years female

•Co/ sudden appearance of black curtain in front of left eye with marked diminution of vision

•Past history of wearing heavy glasses for long period

•Comment:

•DD

•Investigation

•Management

Case 6

•A Male diabetic patient aged 50 years old.

•Came to complain of a rapid diminution of vision of the left eye, with photopsia and micropsia, the duration of diabetes was 15ys.

•There was positive family history.

•On examination it was found that the visual acuity after correction of the Rt eye was 6/12 & the left eye was C.F. 3/60.

•By fundus biomicroscopy the macular area was found edematous with spots of deep hemorrhage.

•Comment

Case 7

•45 years old female

•C / O headache

•VA 6/6 OU

•Fundus:

•Hyperemic congested optic disc head with blurring of the margins

•Comment

•DD of ocular causes of headache

•Clues to the diagnosis

•Further investigations

•Management

Case 8

•Fatty female pt

•40 ys

•Coming C / O difficult near work

•VA : 6/6 OU

•No abnormal data

•Fundus: large assymmetric optic cup

•IOP was 27 mm Hg in both eyes

•Comment

•DD

•Clues to diagnosis

•Investigation

•Management

Case 9

•An infant aged 1 month

•Mother noticed right eye lacrimation & photophobia

•Comment

•DD

•Management

Case 10

•Male patent 60 years old

• Co/ sudden appearance of diplopia interferring with his daily life

•Past history of NIDDM 10ys, hypertension

•Examination:

•Right esotropia 30°

•Normal fundus

•Comment