Ophthalmology · Model history
A dark curtain spreading across her vision: a model ophthalmology history
- Setting
- Emergency eye clinic
- Patient
- Ms. Baker, 58, has a painless dark shadow spreading across her right eye since this morning.
- Listen
- 3 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“Yes, yesterday afternoon I started seeing lots of little dark specks, like a swarm of gnats, and bright flashes of light off to the side.”
Ask directly whether there is any pain or redness in the eye.
Is there any pain or redness in the eye?
Model interview
Full transcript
- Doctor
Ms. Baker, I'm Dr. Whitfield. Tell me what's happening with your vision.
- Patient
There's a dark shadow spreading across my right eye. It started this morning, and it's getting worse.
- Doctor
Can you describe the shadow? Where did it start, and is it still spreading?
- Patient
It started low, near my nose, like a curtain rising from the bottom. Now it's covering more of the center of my vision.
- Doctor
Did you notice anything before the shadow appeared, like flashes of light or new floaters?
- Patient
Yes, yesterday afternoon I started seeing lots of little dark specks, like a swarm of gnats, and bright flashes of light off to the side.
- Doctor
Is there any pain or redness in the eye?
- Patient
No, no pain at all, and it doesn't look red.
- Doctor
Are you very nearsighted, or do you wear a strong glasses prescription?
- Patient
Yes, I'm extremely nearsighted, I've worn a strong prescription my whole life.
- Doctor
Have you had any eye surgery before, like cataract surgery?
- Patient
Yes, I had cataract surgery on that same eye about two years ago.
- Doctor
Has your vision in the other eye changed at all?
- Patient
No, my left eye seems completely normal.
- Doctor
Have you had any head or eye injury recently?
- Patient
No, nothing like that.
- Doctor
Do you have any other medical conditions, like diabetes or high blood pressure?
- Patient
No, I'm generally healthy.
- Doctor
Any regular medicines or medicine allergies?
- Patient
No regular medicines, and no known allergies.
- Doctor
What are you most afraid of right now?
- Patient
I'm terrified I'm going blind in that eye, and that it's happening right now while we're talking.
- Doctor
What were you hoping we could do today?
- Patient
I want to see a specialist immediately and get whatever surgery or laser treatment I need to fix it.
- Doctor
Let me make sure I understand. Starting yesterday afternoon you noticed new floaters and flashes of light in your right eye, and this morning a painless dark curtain began rising from the lower inner part of your vision and has continued to spread toward the center. You have high myopia and prior cataract surgery in that eye, with no pain, redness, injury, or change in the other eye. Is that accurate?
- Patient
Yes, that's exactly right.
- Doctor
Thank you. Everything you're describing is very concerning for a retinal detachment, which is a genuine eye emergency, especially since your risk factors, high myopia and prior cataract surgery, make it more likely. We need to get you to a retina specialist right away. Until then, please try to keep your head still and avoid bending over or straining, and we'll give you specific positioning instructions once the specialist has assessed exactly where the detachment is.
- Patient
Okay, I'll do exactly what you say. I just don't want to lose my sight.
Flow at a glance
The route through the history
- Invite the patient's description of the shadow
- Characterize the visual field defect and its progression
- Ask about preceding floaters and flashes
- Confirm the absence of pain or redness
- Establish risk factors: myopia and prior eye surgery
- Check the unaffected eye and rule out injury
- Review background, medicines, and allergies
- Summarize and activate the emergency referral
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
Editorial update: