Ophthalmic Hx and Examination Flashcards Preview

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Flashcards in Ophthalmic Hx and Examination Deck (65)
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1

What is important in the history of eye issue

MUST rule out emergencies
Uni or bilateral
Time of onset
Permanent or transient
Relieving factors and precipitants
Normal baseline
Recovery - full or partial
Associated Sx
Associated conditions - HTN / DM

2

What do you want to know about red eye

Change in vision
Pain
- What is it like
- How long for and when does it happen
Any other Sx or associated features
Discharge
Double vision
Any floaters / halo
Headache

3

What do you want to know about change in vision

Uni or bilateral
Sudden or gradual
Recovery
Transient - i.e. better after blinking or permanent
Type of loss - blurred/ tunnel
PAINFUL OR PAINLESS
Associated Sx - pain / red / discharge
Any amblyopia

4

What do you want to know about pain

Is it painful or just discomfort / grit
Ocular surface pain (blepharitis, conjunctivitis, keratitis, ulcer, dry eyes)
- Gritty
- FB sensation
- Sharp
Internal ocular (uveitis / scleritis / glaucoma)
- Throbbing
- Dull ache
Pain on movement
- Optic neuritis
- Scleritis
Anything that makes it better - painkiller / eyedrops
Anything that makes it worse - light / movemnt
Associated Sx

5

What associated Sx

Visual disturbance
Diplopia
Distortion
Photophobia
Headache
Pain within eye
Pain around eye - sinusitis
Floaters
Trauma to eye
Discharge- watery vs pus
Dry eyes
Blocked nose
itch

6

What do you want to know about discharge

Colour
Type
Constant or intermittent
Acute or chronic
Itch

7

What do you want to know about double vision

Uniocular (present when covering one eye)
Binocular (relieved covering one eye)

8

What does uniocular suggest

Ocular issue

9

What do you want to know

Onset
Releiving factor
Distortion which suggests macular cause

10

What does binocular suggest

Neuro problem e.g. cerebral artery aneurysm

11

What do you want to know

Vertical or horizontal
Sudden or gradual
Permanent or transient
Precipitants
Relieving
Associated neuro

12

What is important in past ophthalmic Hx

Has it happened before
Eye surgery
- Strabimus
- Cataract
- Laser
Contact lenses use
- Last assessment, how long and how cleaned
Ambylopia in childhood
Any trauma

13

What is important in PMH

HTN or DM
Atopy
CVS RF
Joints
Bowels for IBD
Exposure to infections - any sinus infections

14

What is important in social HX

Recent travel
Smoking
Alcohol
Drugs
STI
Animals

15

What do you look for in inspection

Facial asymmetry
Rash
Lid position
Globe abnormality
Pupil asymmetry
Any lumps / red / discharge

16

What are types of lid position

Ptosis - dropping
Entropion = inverted so lashes can rub against eye
Ectropian = everted + droopy

17

What are globe abnormalities

Proptosis = forward
Enopthalmos = posterior

18

What is acute red eye typically affecting

Anterior segment

19

What does visual loss tend to affect

Posterior segment

20

What is the best way to examine eye

Front to back
Assess vision
Assess anterior segment
Assess posterior segment

21

How do you examine

General inspection
Visual acuity
Colour vision
Pupils
Slit lamp
Fundoscopy - optic nerve
Optic nerve
Ocular movement

22

What do you need

Snellen chart
Opthamloscope
Slit lamp

23

How do you assess visual acuity

Visual acuity with Snellen chart
- Do each eye separate
- Wear glasses

24

What should you do if vision reduced

Ask to look through pinhole
This will correct refractive error

25

What is used to assess visual field

Using fingers will only show gross defect
If suspect need to refer for formal testing
Perimetry
Field Analyers will change colour for defects
Used to asses neuro / glaucoma - peripheral

26

What will macular hole cause

Central loss or distortion

27

What will retinal detachment cause

Peripheral field defect

28

What does a monocular defect suggest

Problem in that eye or optic nerve to chiasm
After dicussation any lesion will cause defect in both eyes

29

Optic nerve disease

Central scrotoma

30

How does retinal disease present

Causes defect in opposite half of visual field
A large scar in inferior retina will cause a superior field defect
Inferior branch retinal vein occlusion = monocular superior loss