Ocular and Systemic diseases associated with pain in and around the eye
Hadley Saitowitz, OD
Case 1:
A 70-year-old white male presents with double vision and pain of 2-day duration.
Clinical evaluation reveals a right upper lid ptosis, mid dilated pupil and down and out
presentation in primary gaze.
Diagnosis: Pupil involved third nerve palsy
Case 2:
A 45-year-old male presents with pain on side of face of 1-day duration with left sided
numbness. Clinical evaluation reveals a right upper lid ptosis, miotic pupil greater in dim
illumination.
Diagnosis: Carotid dissection
Case 3:
A 75 year old white female presents with 2 day onset of pain on left forehead with
radiation to temporal and occipital lobe. Clinical evaluation reveals a vesicular skin
eruption in the region of frontal lobe, with a red eye.
Diagnosis: Herpes Zoster Virus
Case 4:
A 76-year-old white male presents with a headache of 3-day duration, with tenderness
and swelling in the region of his temporal lobe. He also reports a transient visual loss,
which occurred that day which prompted his visit.
Diagnosis: Temporal Arteritis
Case 5:
A 25-year-old white female presents with blurred vision and pain on eye movements of
1-week duration. Clinical evaluation reveals a positive relative afferent papillary defect,
red desaturation greater on the affected side and reduced color vision.
Diagnosis: Optic Neuritis
Case 6:
A 60-year-old white female presented with focal tenderness and swelling in her right
peri-orbital region. She reports pain with eye movements. Her medical history is notable
for recurrent sinus infections.
Diagnosis: Preseptal cellulitis secondary to sinusitis.
Case 7:
A 55-year-old white male presents with a painful left eye of 2 days duration. One week
prior to this he had been seen in the emergency room with a metallic foreign body, which
had been removed without complication. His previous ocular history was notable for
bilateral lasik, 6 years ago. Clinical evaluation revealed a diffuse stromal haze with mild
injection.
Diagnosis: Diffuse Lamellar Keratitis
Case 8:
A 30-year-old white female with a history of contact lens wear presents with pain,
photophobia and reduced vision since removing her lenses the previous night.
Clinical examination reveals a large epithelial defect with sodium flourescein staining.
Diagnosis: Contact lens related corneal abrasion
Case 9:
A 40-year-old white male presents with pain, photophobia and reduced visual acuity on
awakening this morning. He has a history of 30 day extended wear contact lenses, which
were last replaced 10 days ago. Clinical examination reveals a central epithelial defect
with underlying infiltrate and anterior chamber reaction.
Diagnosis: Microbial keratitis
Case 10:
A 77-year-old white male presents with a painful right eye of 1-day duration. His
previous ocular history is notable for filtering surgery for uncontrolled glaucoma. Clinical
evaluation reveals a thin microcystic bleb with injection and positive seidel sign.
Diagnosis: Blebitis
Case 11:
A 25-year-old white male presents with pain in his right eye on awakening. He reported a
history of kerataconus and wears piggyback contact lenses. Clinical evaluation revealed
central corneal edema with a raised nodule and overlying punctate staining.
Diagnosis: Corneal Hydrops
Case 12:
A 40-year-old white male presents with pain, photophobia and blurred vision of 5 days
duration. Clinical evaluation reveals circumlimbal injection, grade 2 cells and flare.
Diagnosis: Anterior Uveitis