Blurry vision

A 50-year-old white female presented to the emergency room complaining of blurry vision. Over the past two weeks, she had had progressively worsening blurry vision and loss of peripheral vision in her right eye. She reported increasing right eye pain for the past three days that was worse with eye movements. She also had had mild right-sided headaches that were described as pressure behind the eye and were worse with leaning forward.

1. Left-sided deafness and facial numbness (1991)-negative work up at Richardson General Hospital, deafness persisted
2. Benign left breast tumor s/p lumpectomy (1998)
3. Bilateral tubal ligation

1. Ibuprofen 600mg three time daily for eye pain

Mother died from pulmonary embolism (age 71)
Father died from colon cancer (age 70)
Brother who is 30 and had thyroid cancer at age 20
Five other brothers and two sisters who are alive and healthy

She reported decreased appetite and an eight-pound weight loss over the past one month. She also mentioned some left hip pain for the past month. She denied fever, chills, recent head trauma, dysarthria, muscle weakness, changes in hearing, chest pain, shortness of breath, cough, or abdominal pain.

Gen:  Well-developed middle-aged female in no acute distress

HEENT:  Pupils equally round and reactive to light. Visual acuity 20/20 bilaterally. Right temporal visual field cut, but left eye visual fields normal. Funduscopic exam normal on left, but right eye medial retina blocked by a mass. Right and left optic disks normal. Extraocular muscles intact bilaterally, but pain elicited upon moving the right eye. Nasal and oral mucosa pink and moist. Bilateral tympanic membranes intact. NECK: Supple with a 0.5cm lymph node in posterior cervical chain. No JVD, thyromegaly, or bruits.

Lungs: Normal work of breathing. Clear to auscultation with no rales, rhonchi, or wheezes.

Breasts:  Symmetrical without any palpable masses orlymphadenopathy.

Cardiac: Regular rate and rhythm. Normal S1 and S2 without murmurs, rubs, or gallops.

Abdomen: Soft, non-tender, non-distended with normo-active bowel sounds. Mild pain with palpation of left inguinal region, but no rebound tenderness or guarding. No masses palpated, and hemoccult negative.

Ext: Warm with 2+ dorsal pedis and radial pulses. No clubbing, cyanosis, or edema

Neurological:  Alert and oriented x 3. Cranial nerves III through XII intact (see HEENT). Motor and sensory function grossly intact. Ankle and biceps reflexes 2+.

Lymph nodes:  No palpable inguinal or axillary lymph nodes

Skin: No rashes