A detailed history of the chief complaint and circumstances surrounding the onset should be obtained. The past ocular and medical history will provide additional information and help you arrive at a differential diagnosis. With this information you can then focus your physical examination and enhance your opportunity to correctly diagnose and treat the condition. A history of sudden, painless monocular visual loss associated with a history of atrial fibrillation or carotid stenosis would suggest a central retinal artery occlusion, while a history of eye pain occurring while hammering metal on metal would suggest a projectile corneal or intraocular foreign body. Past visual acuity and presence of a refractive error (need for glasses or contact lenses) provides information on acuity testing expectations. Use of soft contact lenses, especially the extended-wear type, is associated with a higher incidence of corneal ulceration from microbial infection. Flashing lights and a "curtain or veil" obstructing a portion of the visual field suggests a retinal detachment. A history of diabetes or chronic hypertension and acute isolated sixth-nerve palsy suggests an ischemic cranial neuropathy. A careful medical history and history of present illness (HPI) will guide you toward an accurate differential diagnosis in the majority of cases.
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