Game 1

Solve
in
1

A patient enters. His name is John, and he's 55 years old. He starts off by complaining:

"oh for goodness sakes. this tearing is bugging my vision like it did last time"

His eyes are fairly red.

Seems to be unilateral, only affecting the right eye. The lighting is dark, so far this is all you see.

You set up your slitlamp to view his eye and maybe get some culture.

it is here you see red dots in his adnexa that cause you to change your mind.

Instead, you decide to do staining

You have two stains at the ready. One is fluorescin, the other is rose bengal.

You chose fluorsecin, and weird patches of green appear, kinda resembling blooming flowers.

You use the indirect illumination to view the peripheral cornea. No neovascularisation.

You ask John about how it feels.

"I already told you man, I'm tearing up, I can't see out my right eye when its super watery, and it feels like something is in my eye."

You give him the diagnosis

HSV Induced Epithelial Keratitis

- Ulcers will appear like pedals with terminal bulbs.

- Only slight red eye, and pain is not always present

- He said "like last time," indicating recurrence, along with unilateral

- HSV is known to reside in ganglia of V5 on the ophthalmic branch.