ADNEXAL CASE SCENARIOS Harvard Case Solution & Analysis

Adnexal Case Scenarios Case Study Solution

Findings

A50-year-old male patient who had to face irritation on both eyes as the patient’s both eyes were swelling and were slightly blurred. The swelling of both eyes indicated that the patient was experiencing Orbital Cellulitis. By looking at the image, the symptoms of the swelling of eye clearly indicate that the patient had Orbital Cellulitis as he had eye irritation, dryness, and blurry vision.

His visual acuity of both right and left eye was 6/9 which shows that the patient was unable to read small letters while standing 9 meters away from the Snellen’s chart but was able to read the chart when standing 6 meters away. The left IOP of the patient was in normal range as it was 12 while the right eye had 23 IOP which indicates a higher intraocular pressure. However, in one of the research, it was shown that the right IOP of the older patient was higher than the left eye and the patient did not have glaucoma (Sit & Liu, 2005).

The patient did not have arelatively afferent pupillary defect as both the eyes had eyes constrict equally during the normal swinging light test. The Ishihara test of the patient was normal of both the eyes as the right had 14/15, whereas the left eye had 15/15 which showed that the patient did not have color deficiencies.

Differential Diagnosing

There were several steps for diagnosing the patient’s eyes which were through the following:

  • Conducting the Ishihara test for checking the color defection of the patient
  • Asking the patient’s family history whether the patient’s other relatives had the similar eye problems.
  • The normal switching light test for measuring the signs of relatively afferent pupillary defect.
  • The common Snellen’s chart exam for checking the vision of the patient’s eye.
  • Measuring and checking the intraocular pressure of the eyes for determining Glaucoma.

Further Diagnosing

Since the main issue was the ocular irritation in both eyes and swelling of the eyes, the differential diagnosing which would further be conducted to determine the exact issues is through the clinical examination to determine:

  • Pain during eye movements
  • Involvement of the optic nerves
  • Proptosis
  • Ophthalmoplegia
  • Trauma
  • Inflammation
  • Systematic disease(Mawn, 2017)

Management

The management of orbital cellulitis would be through prescribing the patient with the antibiotics.The best and common antibiotics for treating this disease are vancomycin and clindamycin.

Scenario 2

Findings

A patient who is a65-year-old female had been complaining that her eyes are in discomfort due to blurred vision and tearing. Since her work involved working long hours on computer, it may indicate that the patient has computer vision syndrome as the vision was blurred and there was eye irritation(Dhar-Munshi, 2017). The patient was also unable to go outside during sunny conditions as it caused great discomfort to her eyes.

The visual acuity of the right eye was 6/9 which indicates that she was unable to read small letters while standing 9 meters away from the Snellen’s chart but was able to read the chart when standing 6 meters away. The left eye was 6/7 and this indicates that she was unable to read small letters while standing 7 meters away from the Snellen’s chart but was able to read the chart when standing 6 meters away. This shows that the left eye is much weaker than the right eye.

The tear breakup time for the right eye was around 5 seconds whereas the left had around 3 seconds. The left eye had less than normal tear breakup time which is less than 5 seconds which indicates that the patient has a high chance of dry eye symptoms. The Schirmer 1 test of the Right eye is 5 mm, whereas the left eye 3 mm is considered as a severe dry eye(Dry Eye Zone, Dry Eye Zone).

Differential diagnosing

The several steps for diagnosing the patient’s eyes were the following:

  • The common Snellen’s chart exam for checking the vision of the patient’s eye.
  • Using the tear breakup time test and Schirmer test for examining the dryness of the eye as the patient had teary eyes
  • Asking the patient’s family history whether the patient’s other relatives had the similar eye problems.

Further Diagnosing test

            After diagnosing the patient, the symptoms which she had been experiencing led to computer vision syndrome which is causing weakness, blurry vision and irritation. However, further diagnosing tests are required to determine the real cause of the disease. The following are the further diagnosing tests:

  • By again measuring the visual acuity of the eye for measuring the current vision
  • Intraocular pressure exam for measuring the pressure of the eye
  • Routine clinical eye examination
  • Hematological investigation
  • Slip lamp examination

Management

The treatment for managing the computer vision syndrome is through the eye drops which are Triphala eye drops and Saptamrita Lauha. These both eye drops help in strengthening the ocular which helps in overcoming pathological conditions such as it would help in improving the eye in terms of dryness, irritation, sunny conditions and others (Gangamma, et al., 2010)........................

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