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Vision loss

  • Common ddx

    • cataracts (gradual, bilateral)
    • macular degeneration (central vision loss, elderly)
    • open-angle glaucoma (visual field loss)
    • migraines (temporary, associated with migraine attacks)
    • diabetic retinopathy (chronic, poorly controlled diabetes, cotton wool spots)
  • Serious ddx

    • closed-angle glaucoma (acute, halo vision, painful, nonreactive pupil)
    • optic neuritis
    • temporal arteritis (temple pain)
    • retinal artery occlusion (cherry red spot)
    • retinal vein occlusion (tortuous retinal veins)
    • vitreous hemorrhage
    • retinal detachment
    • brain tumor (headache)
  • Labs

    • optho, neuro consult
    • consider CT, MRI, carotid doppler
    • ESR if suspect temporal arteritis
  • Pediatrics ddx

    • amblyopia, strabismus (child, EOM defect)
    • retinoblastoma (leukocoria)
  • Other ddx

    • uveitis, iritis, MS, meningioma, orthostasis
  • HPI

    • onset
    • triggering event
    • quality: complete, partial, unilateral vs bilateral
    • aggravates, alleviates
  • ROS

    • fever, rash
    • headache
    • eye pain
    • chest pain, palpitations, dyspnea
    • nausea, vomiting, diarrhea, abdominal pain
    • paresthesia, weakness
  • PMH

    • diabetes
    • afib, carotid artery atherosclerosis
  • FH

  • SH

  • Meds

  • Allergies

  • Px

    • vitals
    • gen impression
    • vision: gross, card, fields
    • eye: inspection (redness), pupils, EOM
    • funduscope (cotton wool spots, cherry red spot, tortuous veins, hemorrhage, retinal detachment, papilledema)
    • cardio: afib, pulse, carotid bruits
    • pulm
    • abd
    • neuro: strength, sensation, reflex

  • Print | Citations

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