Question

A 61 year old patient comes to the clinic today with sudden onset of blurred vision and eye pain. She states that she began feeling nausea in the morning, which has worsened. Upon examination the nurse practitioner finds fixed and mid-dilated cloudy pupils that are oval. Pupil reaction is sluggish. What should the nurse practitioner do next?

a. Ask the patient if they use recreational drugs
b. Refer to ED
c. Assess the patient for Sjogren's syndrome
d. Refer to ophthalmology

Answer 1

The nurse practitioner should immediately refer the patient to the emergency department due to symptoms indicative of an acute angle-closure glaucoma attack, which requires prompt medical intervention to prevent permanent vision loss.

Step-by-step explanation:

The nurse practitioner should next refer the patient to the emergency department (ED). The symptoms described by the patient, including sudden onset of blurred vision, eye pain, nausea, and the presence of fixed, mid-dilated, and cloudy pupils with sluggish reactions, suggest an acute angle-closure glaucoma attack, which is a medical emergency.

Excessive intraocular pressures, which are characteristic of glaucoma, can be detected reliably and sometimes controlled effectively, but immediate intervention is required to prevent permanent vision loss. Referral to ophthalmology is also important, but in this instance, the acute nature of the symptoms warrants an immediate emergency department referral.