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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Differentiate between the various ophthalmic disorders using patient-specific information

  • Choose an appropriate treatment regimen for an ophthalmic disorder

  • Discuss the product differences that direct the selection of ophthalmic medications

  • Educate patients about ophthalmic disease states and appropriate drug and nondrug therapies

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PATIENT PRESENTATION

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Chief Complaint

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"My eyes are so red and watery. It started 2 days ago in my right eye and now my left eye is just as bad. I want to wear sunglasses because the light is making them water more. I hate coming to the office so you know I think it's serious."

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History of Present Illness

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Lena Petz is a 53-year-old woman who comes to see her physician because currently both of her eyes are red and watering (Figure 69-1). Two days ago, she noticed that her right eye was irritated and looked a little red, but she just figured that it was because she had been up late the previous night grading projects. She tried a couple drops of Visine but did not notice much difference. Yesterday, she noticed that she had to wipe away a watery discharge from her eye several times during the day. Today when she woke up, her left eye looked the same as the right. She thinks they look redder than yesterday and are watering more and now she is light sensitive. She mentions that a lot of the children in her classes have been coughing and sniffling and having watery eyes recently.

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FIGURE 69-1.

Viral conjunctivitis. (Adapted, with permission, from Usatine RP, Smith MA, Mayeaux Jr EJ, Chumley H, Tysinger J. The Color Atlas of Family Medicine. New York, McGraw-Hill, 2009, Fig 15-1.)

Graphic Jump Location
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Past Medical History

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Osteopenia diagnosed 1 year ago

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Type 2 DM diagnosed 2 years ago

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HTN diagnosed 7 years ago

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Family History

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Mother has osteoporosis and HTN, and is alive at age 78. Father had lung cancer and died at age 60. She has a brother and a sister, who both have HTN and hyperlipidemia.

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Social History

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Married and lives with her husband of 32 years; has no children. Works as an art teacher at a local elementary school. Walks with husband 1 mile 3 days a week for exercise.

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Tobacco/Alcohol/Substance Use

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Social drinker (one to two drinks per week) (−) Tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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Penicillin (breaks out in hives)

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Medications (Current)

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Glucophage 500 mg PO q 12 h

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Lisinopril 20 mg PO daily

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