- Welcome
- Topic 1: Background of Ocular Sympathetics
- Topic 2: Elements of the Case History
- Topic 3: Clinical Tests
- Topic 4: Confirmatory and Diagnostic Tests
- Topic 5: Patient Education
- Topic 6: Treatment and Referral
- Conclusion
- HELP
Case 1
Directions
Read the following case, and complete the activity at the bottom of the page.
A patient entered the examination room with a complaint of sudden-onset right-sided headaches X 1 week. The clinician asked the patient whether the headaches seemed to get worse upon reading, which the patient denied.
Entering visual acuity, chair skills, and manifest refraction were unremarkable except for mild myopia OU. The patient refused dilation, so a quick slit-lamp examination was performed with undilated 90D fundus evaluation, which was unremarkable.
The patient was given -1.00 DS OU spectacles. The doctor recommended the patient take ibuprofen for his headaches, and see his regular doctor if they did not get better soon.
The entire examination took 20 minutes, start to finish.
One year later, the doctor received a notice from a lawyer that the doctor had missed the presentation of Horner’s syndrome, which, in this case, was caused by a malignant tumor. Because of the delay in diagnosis (claimed as malpractice), the patient requested pain-and-suffering damages of $1,000,000.
Activity
Using pencil and paper, please compose a paragraph describing the following:
- Why was the diagnosis of Horner’s syndrome missed by the clinician, based on the information provided in Case 1?
- What should the doctor have done differently in his case history?
- Why do you think the condition was not caught upon pupil testing?
Move on to the next page when you are done.
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