what does SOAP stand for?
S: subjective, chief complaint (symptoms)
O: objective, all exam observation and findings (signs)
A: assessment, diagnosis
P: plan, treatment and patient insturctions
blur at distance
tenative diagnosis is myopia or astigmatism. test with refraction
blur at near
hyperopia, presbyopia. refraction used to test
corneal swelling, dirty contacts, cataracts, dry eye. refract but look at cornea, contacts and ocular lens
Causes and testing if pt sees shadows around letters
astigmatism or cataracts. refaction with specific health evaluation attention to slit lamp and lenses
photopsia describe brief and long and testing
unusual light flashes.
brief flashes (1-3 secs)= retinal etiology
long flashes (1-30 mins)= transient ischemic attack/ migraine
dilate to check peripheral retina and explore migraine/ stroke history
floaters - spots in front of eyes. What are two cases?
New onset, changing or associated with flashes make retinal exam a priority
longstanding floaters are less concerning
binocular= vergence or neurological problem
monocular= opitcal or retinal problem
check history via FODLARS.
words blur after 10-20 mins of near work and blur at distance.
Patients under 35 with spasm of near focus need Visual Efficiency Evaluation
Patients 35y or older near work/presbyopia eval
who requires visual efficiency evaluation?
patients under 35 with accommodation complaints
who recquires near work/ presbyopia evaluation?
patients over 35 years old with accommodative dysfunction
List some symptoms of binocular and vergence dysfunction
double vision at night, double vision when reading, discomfrot around eyes, skipping lines or losing place when reading.
WHat can you check for ocular discomfort (asthenopia)
check tear film quality and dry eye questionaires
What is photophobia?
List 3 possible causes, and 2 tests that can be done
abnormal sensitiviy to light. Usually due to infection or trauma, can be pathological. Careful uveitis eval and dry eye eval.
take them seriously. may need to refer/consultation. may require visual field exam and or neuro-exam
about half of users have eyestrain, fatigue, headaches, blur at near
What questions do you ask a contact lens wearer
how long have they worn contacts, type of lens, hygiene, duration of wear, past infections and comfort level
gaurdian present at all times, the gaurdian will give the history. need written consent to dilate. ask questions regarding childs health and school perfromance.
family member can only give history if the patient allows it. must document the relationship if person giving the history
only about 20% of headaches are related. bilateral, achy, dull (non-throbbing), worse at end of day. may be improved by naps
stress related. "band-like"
allergies, associated with cough, postnasal drip, sore throat
usually male (episodic) chronic knife pain. unilateral pain, associated with unilateral stuffy/ running nose
pulsating throbbing. common in females. certain foods and photophobia trigger them
mass effect headache
brain tumor, meningitis, aneurysm, increased intracranial pressure. sub-acute and get worse over the days.
when is a mass effect headache a red flag?
if it is worse in the morning
worst headache of my life?
aneurysm until proven otherwise