NCCPA™ PANCE EENT Content Blueprint eye disorders ⇒ vision abnormalities
| Amaurosis fugax | Patient will present as → an 82-year-old man who presents to the emergency department complaining of vision loss in his left eye. He states that it suddenly appeared as if a curtain was coming down over his left eye. It resolved after five minutes, and his vision has returned to normal. He has a history of coronary artery disease and type 2 diabetes. Transient partial or complete loss of vision in one eye - The most common cause of amaurosis fugax is a cholesterol plaque emboli from a carotid artery plaque
DX: A fundus exam may reveal optic disk pallor, a cherry-red macula, and retinal edema
TX: If it does not resolve spontaneously, treatment is recommended within an hour of the occlusion
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| Amblyopia | Patient will present as → a 5-year-old male is brought by his parents and referred by his teacher for suspected decreased vision in his left eye. His mother had not noticed any vision problems. He has had normal growth and development. On exam, the patient has an abnormal vision screen of the left eye and red reflex asymmetry. Amblyopia (lazy eye) is reduced visual acuity is not correctable by refractive means
DX: screening to detect amblyopia in all children younger than five years of age
TX: Includes correction of refraction error as well as forced use of the amblyopic eye by patching the better eye or blurring with glasses or drops |
| Glaucoma | Patient with open-angle glaucoma present as → a 47-year-old African American male presents for an ophthalmic examination. Medical history is significant for hypertension and type II diabetes mellitus. On slit-lamp examination, there is cupping of the optic disc, with a cup-to-disc ratio > 0.6. Tonometry reveals intraocular pressure of 45 mmHg (normal is 8-21 mmHg). Peripheral field vision loss is noted on the visual field exam. Patient with acute angle-closure glaucoma will present with → a 60-year-old Asian American woman presents with sudden ocular pain. She reports she was visiting the planetarium when the pain started and when she walked outside she saw halos around the street lights. The pain was so bad that she began to vomit. She reports her vision is decreased. Physical examination reveals conjunctival injection, a cloudy cornea, and pupils Open-angle glaucoma: most common, aqueous outflow obstruction
Acute narrow angle-closure glaucoma: Iris against lens, dark environment, acute loss of vision, nausea, and vomiting.
DX: confirmed by tonometry demonstrating increased intraocular pressure
TX: Acute narrow angle-closure glaucoma
Chronic open-angle glaucoma
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| Scleritis | Patient will present as → a 42-year-old white female complaining of a severely painful right eye. The pain is a constant, boring pain that worsens at night and in the early morning hours and radiates to the face and periorbital region. Additionally, she reports a headache, watering of the eye, and ocular redness. Inflammation of the sclera associated with systemic immunologic disease, such as rheumatoid arthritis
DX: On examination, there is ocular redness and pain on palpation of the eyeball. It can cause visual impairment
TX: Refer the patient for prompt evaluation by an ophthalmologist
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| Strabismus (ReelDx) | ReelDx Virtual Rounds (Strabismus )Patient will present as → a 3-year-old girl brought to you by her mother who is worried about her daughter’s “lazy eye.” She reports that her daughter’s symptoms are exaggerated when she has a cold. Past medical history is negative for trauma or headaches. The patient has an asymmetric corneal light reflex and the cover/uncover test reveals a right-sided esotropia. You refer the patient to a pediatric ophthalmologist. Strabismus is defined as any form of ocular misalignment
TX: Patch exercises, if untreated after age two, amblyopia results |
