Scenarios
Practice clinical decision-making across 10 ophthalmology specialties.
Showing 105 scenarios
Accommodative Esotropia
A 3-year-old girl's eyes have started crossing intermittently over the past few months, especially when looking at close objects.
Chemical Burn — Ocular Emergency
A construction worker presents with an alkali splash to the right eye.
Corneal Foreign Body
A factory worker presents with a painful gritty eye after grinding metal without safety goggles — a metallic foreign body with rust ring is embedded in the cornea.
Ocular Hypertension
A 45-year-old woman found to have IOP of 26 mmHg at a routine eye examination with no disc or field abnormalities.
Optic Neuritis
Painful progressive vision loss in a 28-year-old woman — the classic demyelinating presentation and its implications for multiple sclerosis.
Acanthamoeba Keratitis
A contact lens wearer with a history of swimming presents with severe eye pain out of proportion to findings and an early ring infiltrate — a diagnostic and therapeutic challenge.
Acute Angle-Closure Glaucoma
A 55-year-old woman presents to the ED with sudden severe right eye pain, nausea, and halos around lights.
Acute Anterior Uveitis
A young adult presents with photophobia, pain, and blurred vision in the right eye — first episode of iritis with systemic clues.
Acute Dacryocystitis with Lacrimal Abscess
A 50-year-old woman presents with a painful red swelling at the medial canthus with purulent discharge.
Acute Horner Syndrome
New-onset ptosis with miosis in a 42-year-old man after cervical manipulation — localizing a potentially dangerous lesion along the sympathetic chain.
Acute Posterior Vitreous Detachment
A 62-year-old myope presents with sudden onset of flashing lights and a shower of new floaters.
Acute Retinal Necrosis
A 35-year-old immunocompetent male with acute unilateral vision loss, pain, and floaters.
Amblyopia Screening and Management
A 5-year-old boy is referred after school vision screening reveals reduced vision in the right eye despite an otherwise normal-appearing eye.
Arteritic Anterior Ischemic Optic Neuropathy (Giant Cell Arteritis)
Sudden vision loss in a 74-year-old woman with jaw claudication and scalp tenderness — an ophthalmic emergency requiring immediate treatment to protect the fellow eye.
Basal Cell Carcinoma of the Eyelid
A 72-year-old man presents with a slowly growing pearly nodule on his right lower eyelid that has been present for several months.
Branch Retinal Vein Occlusion
A 58-year-old hypertensive male notices sudden blurred vision in the lower visual field of the right eye.
Brown Syndrome
A 5-year-old boy is referred for an unusual limitation — his right eye cannot look up when he turns it toward his nose.
Carotid-Cavernous Fistula
A 65-year-old woman presents with progressive proptosis, dilated conjunctival vessels, and an audible bruit.
Cavernous Sinus Thrombosis
A 28-year-old with progressive bilateral proptosis, chemosis, and ophthalmoplegia after sinusitis.
Central Retinal Artery Occlusion
Acute painless vision loss in a 72-year-old male with atrial fibrillation -- a stroke equivalent requiring emergent workup.
Central Retinal Vein Occlusion
A middle-aged patient presents with sudden painless blurred vision in one eye.
Central Serous Chorioretinopathy
A 38-year-old type-A businessman complains of distorted vision and a central dark spot in one eye.
Chalazion and Internal Hordeolum
A 34-year-old woman presents with a painless lump on her upper eyelid that has been present for several weeks.
Commotio Retinae (Berlin Edema)
A 19-year-old struck by a cricket ball presents with blurred central vision in one eye.
Congenital Cataract
A 2-month-old infant is brought in by concerned parents who noticed a white spot in the left pupil in photographs.
Congenital Nasolacrimal Duct Obstruction
A 3-month-old infant is brought in by her mother with persistent tearing and sticky discharge from the left eye since birth.
Consecutive Exotropia
A 12-year-old boy who had medial rectus recession surgery for esotropia 3 years ago now has his eyes drifting outward.
Convergence Insufficiency
A 16-year-old student presents with headaches and difficulty concentrating while reading, with intermittent double vision at near.
Corneal Graft Rejection
A patient 18 months post-penetrating keratoplasty presents with a painful red eye and decreasing vision — early recognition of endothelial graft rejection is critical to save the graft.
Diabetic Vitreous Hemorrhage
A diabetic patient presents with sudden floaters and vision loss in one eye.
Duane Retraction Syndrome
A 7-year-old girl is noticed by her school nurse to have limited movement of her left eye outward, with the eye seeming to pull backward when she looks inward.
Endogenous Endophthalmitis
An immunocompromised IVDU patient presents with insidious vision loss and vitritis.
Episcleritis
A young adult presents with acute sectoral redness and mild discomfort in the right eye — no vision change, but worried about the redness.
Exposure Keratopathy
A patient with recent Bell's palsy develops a painful red eye with inferior corneal staining from lagophthalmos — corneal exposure demands urgent protective measures.
Eyelid Laceration with Canalicular Injury
A 5-year-old child presents after a dog bite with a medial lower lid laceration.
Filtering Bleb Infection (Blebitis and Bleb-Related Endophthalmitis)
A 58-year-old man with acute red eye, purulent bleb, and hypopyon 4 years after trabeculectomy.
Fungal Keratitis
A 45-year-old farmer presents with a chronic corneal ulcer with feathery margins after vegetable matter injury.
Herpes Zoster Ophthalmicus
A 68-year-old presents with a painful vesicular rash along the forehead and nose tip with an increasingly red and painful right eye.
Herpetic Anterior Uveitis
A middle-aged patient presents with recurrent unilateral anterior uveitis, elevated IOP, and sectoral iris atrophy — the classic triad of viral uveitis.
Hypertensive Retinopathy Crisis
A 42-year-old with headache and blurred vision is found to have BP 240/140 and bilateral disc edema.
Infantile Esotropia
A 4-month-old infant is brought in by parents concerned about constantly crossed eyes since birth.
Intermediate Uveitis (Pars Planitis)
A young adult presents with bilateral floaters and mildly blurred vision — minimal anterior segment findings but prominent vitreous cells and snowbanking.
Intermittent Exotropia
A 6-year-old girl's left eye drifts outward intermittently, especially when she is tired or looking at distant objects, and she squints in sunlight.
Intraocular Foreign Body (Metallic)
A 32-year-old metal worker presents after hammering with sudden eye pain and decreased vision.
Intraoperative Posterior Capsule Rupture
During routine phacoemulsification, you notice a posterior capsule tear with vitreous prolapse — what are your next steps?.
Intumescent White Cataract
A 70-year-old woman presents with sudden painful red eye and a swollen white lens causing acute angle closure.
Irvine-Gass Syndrome
A 65-year-old man presents 5 weeks after uncomplicated cataract surgery with decreasing central vision and metamorphopsia.
Lacrimal Gland Mass Evaluation
A 45-year-old woman presents with painless progressive swelling in the superotemporal orbit and an S-shaped ptosis.
Late In-the-Bag IOL Dislocation
A 78-year-old man presents with sudden monocular diplopia and a crescent-shaped shadow 8 years after cataract surgery.
Malignant Glaucoma (Aqueous Misdirection)
A 62-year-old woman with shallow anterior chamber and elevated IOP 3 days after trabeculectomy.
Mature Cataract — Preoperative Assessment
A 74-year-old retired schoolteacher presents with progressive bilateral vision loss and difficulty recognizing faces.
Microbial Keratitis
A contact lens wearer presents with a painful red eye and a corneal infiltrate.
Necrotizing Scleritis
A patient with rheumatoid arthritis presents with severe boring eye pain unresponsive to drops, with scleral thinning and avascular patches.
Neovascular Glaucoma
A 67-year-old diabetic man with painful red eye, rubeosis iridis, and IOP of 52 mmHg two months after central retinal vein occlusion.
Neurotrophic Keratopathy
A patient with a history of herpes zoster ophthalmicus develops a persistent non-healing corneal epithelial defect with reduced corneal sensation — navigating the treatment ladder for neurotrophic disease.
Non-Accidental Trauma — Retinal Hemorrhages
An ophthalmology consult is requested for a 6-month-old infant admitted with unexplained subdural hematoma and bilateral retinal hemorrhages.
Non-Arteritic Anterior Ischemic Optic Neuropathy
A 52-year-old man with diabetes notices painless vision loss upon waking with an altitudinal field defect.
Normal-Tension Glaucoma
A 62-year-old woman with progressive visual field loss and optic disc cupping despite IOP consistently below 21 mmHg.
Nystagmus Evaluation
A 6-month-old infant presents with bilateral rhythmic eye oscillations and a persistent right face turn noticed since early infancy.
Ocular Myasthenia Gravis
A 30-year-old woman presents with fluctuating ptosis and diplopia that worsens throughout the day.
Open Globe Injury
Metallic intraocular foreign body from hammering — emergent evaluation and surgical triage.
Ophthalmia Neonatorum
A 3-day-old neonate is brought to the emergency department with bilateral swollen lids and copious purulent discharge.
Orbital Blowout Fracture
30-year-old male punched in the left eye — diplopia on upgaze and cheek numbness.
Orbital Cellulitis
A child presents with worsening periorbital swelling, proptosis, and fever — distinguishing preseptal from orbital cellulitis is critical.
Orbital Compartment Syndrome
A 45-year-old male presents with acute proptosis and rapidly declining vision after facial trauma.
Orbital Mass with Progressive Proptosis
A 48-year-old man presents with slowly progressive unilateral proptosis and an intraconal mass on imaging.
Papilledema and Idiopathic Intracranial Hypertension
An obese young woman with headaches and transient visual obscurations — diagnosing and managing a vision-threatening condition.
Pediatric Preseptal and Orbital Cellulitis
A 4-year-old boy presents to the emergency department with painful left lid swelling, fever, and a recent upper respiratory tract infection.
Peripheral Ulcerative Keratitis
A patient with longstanding rheumatoid arthritis presents with a crescent-shaped peripheral corneal ulcer and adjacent scleritis — a vasculitic emergency with systemic implications.
Persistent Fetal Vasculature
A 3-week-old full-term infant is referred with unilateral leukocoria noticed by the pediatrician during the newborn check.
Phacomorphic Glaucoma
A 70-year-old with sudden painful red eye and a white intumescent cataract.
Pituitary Apoplexy
A 45-year-old man presents with sudden severe headache, bitemporal hemianopia, and bilateral CN III palsies.
Post-Operative Endophthalmitis
A 72-year-old woman returns 3 days after uneventful cataract surgery with worsening pain, redness, and rapidly declining vision.
Post-Traumatic Endophthalmitis
Worsening pain and vision 36 hours after open globe repair — the wound is sealed but the eye is dying.
Posterior Capsule Opacification
A 68-year-old woman returns 14 months after successful cataract surgery with gradually declining vision and glare.
Primary Congenital Glaucoma
A 3-month-old infant presents with excessive tearing, light sensitivity, and one eye that appears larger than the other.
Primary Open-Angle Glaucoma
A 58-year-old man referred by his optometrist for elevated IOP and suspicious optic discs.
Proliferative Diabetic Retinopathy with Tractional Retinal Detachment
A long-standing diabetic presents with progressive vision loss from tractional forces threatening the macula.
Ptosis Evaluation and Workup
A 58-year-old man presents with gradually worsening drooping of his right upper eyelid over the past year.
Retained Lens Fragments
A 71-year-old woman presents 10 days after complicated cataract surgery with persistent inflammation, elevated IOP, and corneal edema.
Retinal Arterial Macroaneurysm
A 72-year-old hypertensive woman presents with sudden painless vision loss and a large retinal hemorrhage.
Retinal Detachment
Acute rhegmatogenous retinal detachment in a myopic patient presenting with visual field loss.
Retinoblastoma
A 2-year-old child is referred after parents noticed a white glow in the right pupil in flash photographs and the pediatrician confirmed leukocoria.
Retinopathy of Prematurity
A premature infant born at 28 weeks gestation (birth weight 1000g) presents for routine ROP screening at 4 weeks of age.
Rhino-Orbital-Cerebral Mucormycosis
A 55-year-old diabetic man in ketoacidosis presents with rapidly progressive orbital involvement, black nasal eschar, and vision loss.
Sarcoid Uveitis
A middle-aged patient presents with bilateral granulomatous anterior uveitis — mutton-fat KPs, iris nodules, and tent-shaped PAS point toward a systemic granulomatous disease.
Sixth Nerve Palsy Evaluation
A 55-year-old diabetic presents with acute horizontal diplopia worse at distance and an esotropia.
Steroid-Response Glaucoma
A 34-year-old man on chronic topical steroids for anterior uveitis presents with IOP of 38 mmHg and early optic disc changes.
Stevens-Johnson Syndrome / TEN Overlap (Ocular)
A 22-year-old presents with acute bilateral conjunctival inflammation, pseudomembranes, and skin target lesions with ~15% BSA epidermal detachment after starting a new medication.
Superior Oblique Palsy
A 35-year-old man presents with vertical diplopia and a head tilt that has worsened since a minor car accident 3 weeks ago.
Suprachoroidal Hemorrhage
A 78-year-old anticoagulated male develops acute pain and vision loss during cataract surgery.
Sympathetic Ophthalmia
A 40-year-old develops bilateral granulomatous panuveitis 3 weeks after penetrating eye injury.
Third Nerve Palsy
Acute-onset ptosis and diplopia in a 55-year-old woman — ruling out a life-threatening posterior communicating artery aneurysm.
Thyroid Eye Disease with Compressive Optic Neuropathy
A 45-year-old woman with Graves disease presents with proptosis, diplopia, and decreasing color vision.
Thyroid Restrictive Strabismus
A 45-year-old woman with Graves' disease develops progressive vertical diplopia that worsens when she tries to look up.
Toxic Anterior Segment Syndrome (TASS)
A 62-year-old man presents 18 hours after uneventful cataract surgery with diffuse corneal edema, hypopyon, and minimal pain.
Toxoplasma Retinochoroiditis
A young patient presents with unilateral floaters and decreased vision — fundoscopy reveals a white retinal lesion adjacent to an old pigmented scar with dense vitritis.
Traumatic Corneal Abrasion
A young woman presents with acute eye pain after her toddler's fingernail scratched her eye during play.
Traumatic Hyphema
14-year-old struck in the eye by a paintball — layered blood in the anterior chamber with elevated IOP.
Traumatic Iridodialysis
A young man presents with monocular diplopia and glare weeks after a fist strike to the eye — the pupil appears D-shaped.
Traumatic Lens Subluxation
A 25-year-old boxer presents with monocular diplopia and a trembling iris after blunt trauma.
Traumatic Optic Neuropathy
28-year-old cyclist with sudden vision loss after motor vehicle collision — no obvious eye injury.
Uveitic Glaucoma
A 42-year-old woman with chronic anterior uveitis and elevated IOP despite controlled inflammation.
Vogt-Koyanagi-Harada Disease (Acute Phase)
A 32-year-old Asian woman presents with bilateral blurred vision, headache, and meningeal signs.
Wet AMD with Submacular Hemorrhage
An elderly patient with known AMD presents with sudden central vision loss.