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Answers: 2006 Series -  July 25, 2006 Lecture 23 of 52  NEXT»

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On dilated exam, a first time patient with unremarkable past medical and ocular history has 20/20 vision in both eyes and an IOP of 23 OD and 21 OS.  On dilated fundus exam, the above clinical picture is observed.

1.  Which of the following is most remarkable on this exam:
 

c -- cup-to-disc asymmetry

 

2.  What should be the next test ordered:

 

 

c -- visual field and follow the patient's IOP closely

This patient has cup-to-disc asymmetry with an enlarged cup and thinning of the rim on the right optic nerve.  On the exam today, the IOP is mildly elevated and this patient should be evaluated for glaucoma, including a baseline visual field and have the IOP monitored closely.  In patients with disc asymmetry one should always ask about past trauma, steroid use, prior uveitic episodes, and perform gonioscopy comparing BOTH angles.

 


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