Recently at the EM Core we discussed headache and the red eye.
I had a great case just over a week ago. A patient was triaged with headache and cataract.
On examination he had a very painful right eye, which was causing the headache. He could only see outlines of my fingers…..He had been like this for one week.
Here is a picture of his eye. What do you think?
He had a ciliary flush(although not a huge one.
He had a cloudy cornea.
Visual acuity is decreased.
Pupil was not reactive.
On fluorescein staining, there was nothing to see.
He had ‘compartment syndrome of the eye’ – angle closure glaucoma.
The definitive diagnosis is made by taking pressures. This also differentiates it from keratitis.
Firstly we had trouble calibrating the ‘tono-pen’, then couldn’t measure a pressure with it. Then the penny dropped. I measured the pressure in the good eye and it was 11. The pen wasn’t measuring pressure as it was too high.
Next to treatment – acetazolamide 500mg IV, Timolol eye drops and alphagan eye drops, then transfer for definitive treatment under ophthalmology.
Great story great pictures. Thankyou
very important subject. Another point to be mentioned for management especially in the Rural setting where an ophthalmologist is not available, is how to do corneal indentation using a cotton stick as a last resort to decrease the IOP until ophthalmologist care is available.
great case and shows how the “headtie” differential can be used to make a diagnosis.
Thanks again
My first thought was Acute Glaucoma but the clouded cornea somewhat put me off. It looked like an ulcer from the distance. Thank God for Fluorescein.
Good story. I like the twist with ‘tono-pen’.
Love the triage diagnosis, ‘headache and cataract’.
This is a spot diagnosis of acute glaucoma if I ever saw one.
Would be funny to compile a sample of triage pearlers, for publication in a discrete place (ie on the internet), as I’ve seen some crackers over the past couple of years.
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