monocular vision loss- loss of vision on one side of the eye cause the person to rely on the other eye

caucasian- europian white people (pale skin)

27-year-old Caucasian female- high risk to get multiple sclerosis, pcos,

painful monocular vision loss- occur by lesion anterior to optic chiasm, issued like cornea ulcer, retinal detachment

developed over the last two days- acute process (due to infection)

HOPI- how & when the vision loss begin to indicate acute or chronic, associated symptoms, started from two eyes or just one eyes, is it affect peripheral vision?,

site-started from two eyes or just one eyes

onset- when the vision loss begin

characteristics- vision loss black, white or grey, vision loss affect far away or close up, have blurred vission or not, pain (dull, stabbing),shadows, dark spot, flashes of light

radiation- does the range of visual field affected, does the pain spread at head, temple, face

associated symptom- change in colour vision, headache, nausea, photophobia, diplopia, balancing problem, eye redness, trauma

time- how long does the symptoms last, intermittent or consistent

exacerbating factor- painful when move the eye, ask anything that make the pain worse, medication that could relieve the pain, does bright light worse the pain

severity- scale (0-10)

past medical history- hs of the eye disease, any ocular problem, eye surgery or trauma, head trauma, CVS, other diseases, diabetes

social history- smoking or drug, alcohol, use contact lens, diet hs

family history- any family member have same Sx, any family member have autoimmune ds

medications- take any drug that related to vision loss, any OTC medication

optic neuritis

Multiple Sclerosis

Thromboembolic from internal carotid artery

glaucoma

orbital tumor

cornea ulcer

iritis

Visual fields were full to confrontation - normal vision

left eye red desaturation - ability of left eye to perceive colour red is reduced, abnormalities in red cones

left relative afferent pupillary defect - condition where there is abnormal response of pupil to light

looking to the extremes of gaze - moving eye as far as possible without tilting head

gait examination - observe how person walk

Vital signs were normal - BP in normal range - loss of vision not due to HTN, temperature normal no infection

On examination, eyes and orbit appeared normal, Visual fields were full to confrontation. - normal vision

Visual acuity was 20/20 on the right eye and 20/40 on the left. - right eye normal , left eye defect vision

There was left eye red desaturation and abnormal colour vision on Ishihara plate testing. - patient left eye has reduced perception to red colour so difficult to distinguish red and green colour

Her pupils were equal in size. - normal pupillary function

A left relative afferent pupillary defect was noted. - RAPD, person noted RAPD associated with acute unilateral optic neuritis

On ophthalmoscopy, the cornea, anterior chamber, lens and

vitreous humor appeared normal in both eyes, as did both optic discs. - anterior part of eye not affected, rule out corneal ulcer

There were no hemorrhages or other abnormal retinal findings. - no defect in eye blood circulation

Eye movements were normal, but she found looking to the extremes of gaze painful in the left eye. - muscle strain and inflammation in optic nerve of left eye

No other abnormal neurological findings were detected. - no neurological disorder causing vision loss e.g stroke

The remainder of the cranial nerve examination was normal. - no abnormalities detect in cranial nerve

Strength, coordination, and sensation were normal, as was a gait examination. - all work normally

A systemic examination was unremarkable. - no related to other systems

optic neuritis

Multiple Sclerosis

Thromboembolic from internal carotid artery

glaucoma

orbital tumor

cornea ulcer

iritis