EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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E W RESIDENTS 1 41 Discussion In a patient with a headache and blurred vision, the review of systems should include asking if the headache woke her up, if she had previously had similar headaches, or if this was the worst headache of her life, and if anything has relieved the headache including laying down. In addition, a family history of mi- graines, history of trauma with head injury, and use of medications including birth control pills and sulfonamide-containing medications should be noted. Documenting associated symp- toms including dizziness, confusion or disorientation, vomiting, fever and neck pain is important. Eye symptoms of flashing lights with patterns, blurry vision at distance or near may help in making the diag- nosis. The examination should also include assessment of vital signs including the blood pressure. T he differential diagnosis includes acute angle closure, malignant hypertension, increased intracranial pressure, infectious central nervous system disorder or migraines. Given the high intraocu- l ar pressure, the diagnosis is acute angle closure, which can be second- ary to pupillary block from narrow angles or plateau iris configuration, and mechanical closure of the angle secondary to anterior displacement o f the lens-iris diaphragm. This can be induced by the lens size, choroidal detachment, posterior segment tumors or choroidal swelling from previous surgery OFFICE SEEM CONGESTED? TIME WITHOUT A PATIENT TO SEE? PLANNING NEW PRACTICE SPACE? HAS THE SOLUTIONS TO YOUR PROBLEMS. ASCRS 2014 BOOTH 1409 "Practice Flow Solutions was the best investment I made in building our new office." Dr. Susan Everhart - Everhart Eye Associates Practice Flow Solutions is a niche design firm uniquely focusing on helping medical practice efficiencies by identifying and solving problems in patient, staff and doctor flow. Larry Brooks , AIA and Tim Griffin, AIA, the fou nders of Practice Flow Solutions, have over 40+ years of experience designing and advising medical practices. www.PracticeFlowSolutions.com F L O W A S S E S S M E N T S S P A C E A S S E S S M E N T S O F F I C E D E S I G N + ONSITE EFFICIENCY STUDIES + IDENTIF Y THE PROPER AMOUNT OF SPACE + MA XIMIZE YOUR WORKFLOW Figure 1: Ultrasound biomicroscopy and B-scan illustrating a closed angle with anteriorly rotated ciliary body and diffuse c horoidal effusions Figure 2: Follow-up ultrasound biomi- croscopy two weeks later with return of normal angle configuration Source (all): Shahzad Mian, MD continued on page 143 March 2014 138-143 Residents_EW March 2014-DL2_Layout 1 3/6/14 4:16 PM Page 141