History of Present Illness (HPI)
A 69-year-old woman with a history of cutaneous melanoma complains of a change in her vision for the last month or so. She has difficulty describing her symptoms, but she reports that things are just a bit out of focus in both eyes (OU). She denies any other eye symptoms and has not had any recent changes to her health or recent hospitalizations.
Questions to Ask
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Have you started any new medications, either for your melanoma or anything else?
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Are you taking any steroids?
She responds that she recently started a new drug to treat melanoma based on “the DNA in the melanoma,” but is unsure of its name. A review of her oncology outpatient notes shows that she is on trametinib, an inhibitor of mitogen-activated protein kinases (MEK). She denies corticosteroid use.
| OD | OS | |
|---|---|---|
| Vision | 20/25 | 20/20 |
| Intraocular pressure (IOP) | 14 | 15 |
| Lids and lashes: | Normal | Normal |
| Sclera/conjunctiva: | White and quiet | White and quiet |
| Cornea: | Clear | Clear |
| Anterior chamber (AC): | Deep and quiet | Deep and quiet |
| Iris: | Flat | Flat |
| Lens: | 1+ nuclear sclerosis (NS) | 1+ NS |
| Dilated fundus examination (DFE): | See Fig. 57.1A | See Fig. 57.1B |
Assessment
Serous retinal detachments, left eye greater than right eye (OS > OD)
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