- The document provides 10 clinical case studies and asks the reader to comment on the diagnosis, differential diagnosis, necessary investigations, and management for each case. It emphasizes taking time to analyze each detail, considering various diagnoses, and developing a logical step-wise approach.

1. Problem Solving

2. Instructions

3. • Analysis of every phrase
• Take care of every word
• Every word has a significance
• Don’t rush to the final diagnosis
• Write in a step wise approach

4. Examples

5. Case 1

6. • Female patient aged 46 years old
complaining of right rapid deterioration of
vision since yesterday with pain,
photophobia, lacrimation and headache.
• A. What is the differential diagnosis of the
case ?

7. • Examination of this case revealed: right eye
VA: 1/60, ciliary injection, corneal edema,
shallow anterior chamber, with dilated oval
pupil. Fundus coul not be examined due to
hazy media.
• Left eye VA: 6/9 with +4 glasses, shallow
AC
• B. Comment on final diagnosis and how to
manage such case

8. Case 2

9. • Male pat. Farmer, aged 6oys came to
complain of diminution of vision (fogy
vision) of both eyes, more in the right eye.
• Gradual, progressive, painless since 6
months in the right eye and recently in the
left eye.
• It is more in the day light.
• No treatment received before.

10. • On examination:
• VA: OD 3/60. OS 6/36 not corrected
• Anterior segment was normal, pupil was
regular and reactive, greyish coloration
of the pupillary area with presence of iris
shadow in both eyes, IOP was normal,
fundus was normal

11. • Comment on the case
• Age: senile problem
• C / O ………...DD
• Exclusion of other pathologies
• Final diagnosis
• Investigation
• Management

12. Case 3

13. • A baby
• Aged 4 months
• Came with his parents; to complain of :

14. • The color of his pupil looks abnormal
• he cannot fix any object or know his
mother
• No other data

15. • Comment
• Congenital anomaly
• DD leucocorea
• Examination under anesthesia
• Investigation

16. Case 4

17. • Male patient 50 years old
• Co/ Left red eye , pain photophopia ,
lacrimation& diminution of vision .
• Past History
• Diabetes millitus
• Chronic inflammation of left lacrimal sac

18. • Comment

19. Case 5

20. • 50 years female
• Co/ sudden appearance of black curtain in
front of left eye with marked diminution of
vision
• Past history of wearing heavy glasses for
long period

21. • Comment:
• DD
• Investigation
• Management

22. Case 6

23. • A Male diabetic patient aged 50 years old.
• Came to complain of a rapid diminution of
vision of the left eye, with photopsia and
micropsia, the duration of diabetes was
15ys.
• There was positive family history.

24. • On examination it was found that the visual
acuity after correction of the Rt eye was
6/12 & the left eye was C.F. 3/60.
• By fundus biomicroscopy the macular area
was found edematous with spots of deep
hemorrhage.

25. • Comment

26. Case 7

27. • 45 years old female
• C / O headache
• VA 6/6 OU
• Fundus:
• Hyperemic congested optic disc head
with blurring of the margins

28. • Comment
• DD of ocular causes of headache
• Clues to the diagnosis
• Further investigations
• Management

29. Case 8

30. • Fatty female pt
• 40 ys
• Coming C / O difficult near work

31. • VA : 6/6 OU
• No abnormal data
• Fundus: large assymmetric optic cup
• IOP was 27 mm Hg in both eyes

32. • Comment
• DD
• Clues to diagnosis
• Investigation
• Management

33. Case 9

34. • An infant aged 1 month
• Mother noticed right eye lacrimation &
photophobia

35. • Comment
• DD
• Management

36. Case 10

37. • Male patent 60 years old
• Co/ sudden appearance of diplopia
interferring with his daily life
• Past history of NIDDM 10ys, hypertension

38. • Examination:
• Right esotropia 30°
• Normal fundus

39. • Comment