DGR #176

Hint #1 | Hint #2
Hint #3 | Hint #4 | Answer

History:
A 52 year old male presents from Primary Care Medicine with multiple complaints and medical problems. The patient is a diabetic of 8 years and is experiencing renal insufficiency, barely managed hypertension. He has glaucoma and is taking multiple drops. They are Xalatan, 1gtt, OU, QD at night; Trusopt, 1gtt, OU BID, Alphagan-P, 1 gtt, OU, BID and Timpotic 0.50%, 1gtt, OU, BID. According to his records, his diabetes is in good control. The patient complained of the following: 1. Upper conjunctival elevation that is irritation and noticeable. 2. Dry, gritty, sandy, and sometimes watery eyes 3. No photophobia, sudden loss of vision 4. No loss of consciousness, diplopia, drowsiness, vomiting, or headache reported. PE: Ta 15/14 in the afternoon. Slit lamp shows no punctate epithelia keratitis, quiet anterior chambers and quiet lids/lashes/conjunctiva of the right eye. See photo of right eye. The left eye is similar in appearance He is wondering why these bumps are bothering him.



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