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Mitsuishi, aged 57 years, is a bookkeeper. She is bothered by a red, irritated left eye that has worsened over the past week. Mitsuishi’s eye is weepy, and her vision is occasionally blurred. She also has a red upper and lower lid on the left.
Mitsuishi has primary open angle glaucoma and uses latanoprost/timoptol daily to both eyes, and brimonidine twice daily to the left eye. She has used this combination of drops for the past three months. 1.What are the possible causes of her symptoms? What history and examination would be appropriate? 2.What is the likely diagnosis, and what are the differential diagnoses? 3.Are there any investigations that can be performed? 4.Assuming this is a reaction to Mitsuishi’s topical medication, what are the next steps? 5.Why would her ophthalmologist have added brimonidine to her medication regimen at her last visit three months ago? 6.What is likely to occur in Mitsuishi’s case? #Week23_Case3
Hye-yoon is an independent woman, aged 72 years, who previously worked as a nurse. She was brought into your surgery by her daughter with a complaint of seeing dots in her vision. Hye-yoon lives on her own, drives herself and helps care for her grandchildren while her daughter works. She has a background of well-controlled type 2 diabetes and wears glasses for myopia. 1.What further questions would you ask Hye-yoon to assist in making a diagnosis? 2.What further assessments would be useful in differentiating Hye-yoon’s presentation? 3.Would you order any urgent investigations? 4.What are your working and differential diagnoses? 5.What risk factors does Hye-yoon have for retinal detachment? 6.How would you explain to Hye-yoon what flashes and floaters are? 7.What advice would you provide to Hye-yoon about driving? 8.Would you urgently refer Hye-yoon to a specialist? #week23_Case2
