ADNEXAL CASE SCENARIOS Harvard Case Solution & Analysis

Adnexal Case Scenarios Case Study Solution


A -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 eyes, irritation and redness indicates that the patient was experiencing Graves’ Eye or Thyroid disease. The Thyroid eye disease is caused by immune cells which attack the thyroid gland and as a result the metabolism increases due to enlargement of thyroid gland hormones. This leads to attacking the tissues of the eyes and causes the eye muscles to expand causing swelling, irritation and pain(Nice Guidelines, 2012).

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.

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

The differential diagnosing would be through conducting test on the exophthalmos which refers to the condition when the eye bulges from the eye socket and both the eye can be affected which is similar to the case. The diagnosis which would be conducted are the following on the exophthalmos

  • Conducting a blood test for analyzing whether the thyroid gland is functioning properly or not.
  • Asking the patients’ family history whether the patients’ other relatives had the similar eye problems.
  • Using the exophthalmometer for determining the axial position of eyes.
  • A CT scan of the brain for analyzing the structure of the brain.
  • A CT scan or MRI for examining the eye sockets for detecting a tumor or any abnormality.

Further Diagnosing

Since the main issue was the thyroid diseasein both eyes and swelling of the eyes, the further diagnosing which wouldconduct to determine the exact issues is through the physical examination to determine that whether:

  • Evaluation of a complete orthoptic or sensorimotor
  • Stereopsis
  • Investigating the optic nerves
  • Measuring the ductions
  • Measuring the ocular alignment through the prism alternate test
  • Color vision evaluation(Grigorian & Suh, 2015)


The management of thyroid disease would be through prescribing the patient with the anti-inflammatory medicinesfor avoiding the risk of vision loss(Briceño, 2013). Other methods for managing the thyroid disease are through using of ocular lubricants, taping the lids closed at night, using prisms on spectacles and also through counseling and therapies (McAlinden, 2014)..................

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