Initial Assessment of the Eye Case 2

1. Question

A 65-year-old woman attends the ED complaining that she has suddenly lost vision in her left eye. She normally wears glasses for reading and driving, has had no previous eye problems and takes a diuretic for hypertension.

You start to assess this patient’s visual acuity. Unfortunately she has only brought her reading glasses with her.

Put the following in order, assuming that, at each stage, the examination is negative.

Sort elements

Step 1
Step 2
Step 3
Step 4
Step 5
Step 6

Read letters on a chart at 6m
Read letters on a chart at 3m
Differentiate hand movements
Count fingers
Read letters on chart at 6m with pinhole occluder
Perceive light

2. Question

Next, you assess the pupil reflexes and perform the swinging light test. Describe what happens:

In a normal reaction
In an abnormal response

3. Question

Match each diagnosis to the appropriate pupil reaction.

Sort elements

Constricted pupil; reacts to accommodation, not to light
Dilated pupil; no reaction to light or accommodation
Constricted pupil; reacts to light and accommodation
Dilated pupil; reacts to accommodation, not to light

Argyll-Robertson pupil
Oculomotor nerve palsy
Horner’s syndrome
Holmes-Adie syndrome