Summary OSCE pupil notes

28-year-old patient
Last eye test was 3 years ago
Doesn’t wear any glasses
Has recently noticed difficulty reading newspaper and her mobile phone
She is also sometimes light sensitive
This all started after an episode of fever 1 month ago
Look at the record and answer questions from your assessor.

Record card:

General health: all ok

Ocular history: all ok

Family history: all ok

Vision: RE 6/7.5 LE 6/7.5

Near N8 N8

Refraction: +0.50 +0.50

Add: +1.00 +1.00

N5 N6

Pupils: LE sluggish reaction to light. LE > RE. slow reaction to accommodation

Questions I was asked:

Summarise the history and symptoms
Summarise the signs
What’s your diagnosis?
How would you manage this patient?

Answers:

Summary of history:
-​ Px has come in complaining of difficulty reading the newspaper and her
mobile phone, unaided
-​ She also reports feeling photophobic sometimes
-​ Symptoms all started 1 month after an episode of fever

Summary of signs:
-​ Px has a small distance rx
-​ She has reduced near vision
-​ A +1.00 add improves her near vision from N8 to N5
-​ Pupil exam shows her LE responds sluggishly to light, her LE pupil is larger
and also has a poor response to accommodation