Ocular Disease: The Eyes Have It-A Photo Quiz

August 6, 2013

The eyes may be "windows to the soul," but they also provide a look at your patients’ overall health and clues to specific disorders. This week’s photo essay will test your ability to identify eye-related problems.

Question 1:
A 20-year-old woman reported an acute onset of itching and swelling of the right eye. She had a swollen, erythematous lower right eyelid and macular erythema of the right infraorbital skin. Wearing "paste on" fingernail decorations, she had used her fingers to hold her lower lids down and insert contact lenses. The diagnosis was contact dermatitis.

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Question 2:
A 43-year-old man who wore soft contact lenses presented with left eye irritation. The left pupil was slightly smaller than the right and reacted more slowly. There also was mild bilateral photophobia and consensual photophobia. The left eye showed injection without discharge. The diagnosis was iritis caused by neurosyphilis.

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Question 3:
A 58-year-old man with type 2 diabetes, nephrolithiasis, and benign prostatic hyperplasia presented with bilateral periorbital ecchymoses, or "Raccoon eyes," and left subconjunctival hemorrhage. The most likely cause was difficulty in voiding, characterized by increased frequency, hesitancy, and diminished urine stream.

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Question 4:
A 45-year-old man of Hispanic ancestry presented with a "growth in both eyes" that had recently become more prominent. Well-defined wedge-shaped growths on the medial aspects of both eyes extended onto the corneas. He had pterygia.

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Question 5:
A closeup view of a man's right eye and orbit shows periocular swelling and erythema confined strictly to the inferior area, sparing the upper lid. Localized redness about the right orbit, centered on the lower lid, permits a diagnosis of preseptal cellulitis.

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ANSWER KEY:



Question 1. Answer: c

Question 2. Answer: e

Question 3. Answer: e

Question 4. Answer: b

Question 5. Answer: d