Paramedic Education at Monroe Community College, Rochester, New York

You see a patient with sudden visual problems that have continued for the last 25 minutes. The 30 yo w F patient c/o painless flashes of light and the feeling that something is hanging in front of her left eye. She is a diabetic (type I) and has had no opthalmic problems in the past. She denies recent trauma or other symptoms.

You note that the EOM are intact, pupils are equal and responsive, and her visual acuity is as follows: O.D. 20/20, O.S. 20/40. A pinhole card does not improve the vision

You perform a funduscopic exam of the right eye and find it to be normal. You look in the left eye and see the following:

What is the most likely diagnosis:

This is a normal fuduscopic exam, consider this to be a non-headache mirgaine

This is case of papiledema and she should be referred to her primary care physician

This is diabetic retinopathy and she should be referred to her primary care physician

This is a retinal detachment and she should be sent by ambulance to the ED

What would be your most pressing concern at this time: Nothing, antibiotics, have her reclined and hold still, check her blood glucose.

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