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Ophthalmology > Ophthalmic Hx and Examination > Flashcards

Ophthalmic Hx and Examination Flashcards

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1
Q

What is important in the history of eye issue

A 
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
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2
Q

What do you want to know about red eye

A 
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
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3
Q

What do you want to know about change in vision

A 
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
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4
Q

What do you want to know about pain

A

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

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5
Q

What associated Sx

A 
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
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6
Q

What do you want to know about discharge

A 
Colour 
Type
Constant or intermittent
Acute or chronic
Itch
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7
Q

What do you want to know about double vision

A

Uniocular (present when covering one eye)

Binocular (relieved covering one eye)

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8
Q

What does uniocular suggest

A

Ocular issue

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9
Q

What do you want to know

A

Onset
Releiving factor
Distortion which suggests macular cause

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10
Q

What does binocular suggest

A

Neuro problem e.g. cerebral artery aneurysm

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11
Q

What do you want to know

A 
Vertical or horizontal
Sudden or gradual
Permanent or transient
Precipitants
Relieving 
Associated neuro
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12
Q

What is important in past ophthalmic Hx

A 
Has it happened before
Eye surgery
- Strabimus
- Cataract
- Laser 
Contact lenses use 
- Last assessment, how long and how cleaned 
Ambylopia in childhood
Any trauma
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13
Q

What is important in PMH

A 
HTN or DM 
Atopy
CVS RF
Joints
Bowels for IBD 
Exposure to infections - any sinus infections
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14
Q

What is important in social HX

A 
Recent travel 
Smoking
Alcohol
Drugs
STI
Animals
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15
Q

What do you look for in inspection

A 
Facial asymmetry
Rash
Lid position
Globe abnormality
Pupil asymmetry
Any lumps / red / discharge
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16
Q

What are types of lid position

A

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

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17
Q

What are globe abnormalities

A 
Proptosis = forward
Enopthalmos = posterior
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18
Q

What is acute red eye typically affecting

A

Anterior segment

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19
Q

What does visual loss tend to affect

A

Posterior segment

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20
Q

What is the best way to examine eye

A

Front to back
Assess vision
Assess anterior segment
Assess posterior segment

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21
Q

How do you examine

A 
General inspection 
Visual acuity
Colour vision
Pupils 
Slit lamp
Fundoscopy - optic nerve 
Optic nerve
Ocular movement
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22
Q

What do you need

A

Snellen chart
Opthamloscope
Slit lamp

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23
Q

How do you assess visual acuity

A

Visual acuity with Snellen chart

  • Do each eye separate
  • Wear glasses
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24
Q

What should you do if vision reduced

A

Ask to look through pinhole

This will correct refractive error

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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
31
When is colour vision common reduced
Optic nerve centrally | Peripherally with chiasm
32
What happens in particular
Red desaturation
33
What is used to test
Colour plates | Use for all suspected optic nerve / neurological disease
34
When is colour normal
Glaucoma
35
How do you assess pupils
Ask to fixate on distant target - Are pupils normal sizes and equal Reduce light - Are pupils still equal Check light response - Shine light in one eye and check direct resposne - Check the consensual response Accommodation - Ask to fixate on distant object - Introduce a new object close and ask them to focus
36
How do you assess eye movement
``` Is there diplopia in primary position Ask patient to follow a target Ask if they have any double vision Ensure not monocular by getting them to cover one eye and making sure it disappears Describe orientation of diplopia ```
37
What commonly causes horizontal diplopia
6th nerve palsy | Decompensated horizontal squint
38
What commonly causes tilted / vertical
4th nerve palsy
39
Diplopia + ptosis
3rd nerve palsy | EMERGENCY
40
If doesn't fit CN pattern
Supranuclear or localised ocular
41
What do you look for in slit lamp examination
Anterior segment - Conjunctiva - Cornea - Iris ``` HYphaema = blood in AC Hypopyan = pus in AC ```
42
What do you look for with conjunctiva
``` Any discharge Does it look bumpy - Allergy - Viral conjunctivitis Any hyperaemia - Episcleritis - superficial - Scleritis - deep - Uveitis - Blepharitis - at lid margins ```
43
What do you look with cornea
``` Clear vs hazy Hazy due to corneal oedema Corneal ulcer = local opacity only Swelling White area in red eye indicates stoma infiltrate in keratitis Add flurosecin ```
44
What does fluroscein do
Looks for epithelial defect - Dendritic ulcer - Infection / abrasion
45
If painful post corneal transplant
Senior help | - Could be infection or rejection
46
What is the anterior chamber
Area between cornea and iris
47
What do you look at in anterior chamber
Is anterior chamber normal depth or shallow - If shallow need to exclude an occludable angle with gongioscopy as cause glaucoma Can you see light in anterior chamber - No usually appears empty and only see light shone on cornea and iris - Suggests inflammation or infection
48
Iris
Is colour the same in both eyes Is it stuck to lens - synechiae (makes pupil irregular and sign of inflammation) Any iris transillumination defects
49
What is tonometry used for
Measure IOP | Too thick fluroscein can underestimate
50
What is gonioscopy
Examine angle Better in dark Cannot exclude an occluded angle without performing
51
What does posterior segment involve
Dilating pupil - essential to see behind the lens Lens Vitreous Fundoscopy
52
Before dilating pupil what should you check
No driving as will blur eye Ensure pupil response checked as won't be able to for 24 hours May be only +Ve sign in optic neuritis
53
What do you use to dilate
Tropicamide - fasted acting | Phenylephrine
54
Most common cause of gradual vision loss
Cataract
55
What do you look for in the lens
Lens opacities - sign of cataract Loose len zonules - blunt trauma Dislocated lens (not in centre) - causes astigmatism Artificial lens implant after cataract
56
What do you look for in vitreous (usually clear)
Dust White cells - vitritis Red cells - haemorrhage
57
What do you do in fundoscopy with opthamolscope
``` Check red red reflex Look optic disc Assess vessels radiating Look at macula Look in all 4 peripheral quadrants of retina ```
58
Important things to note in disc
Swelling CUpping Abnormal vessels
59
Important things to note with macula
Haemorrhage Oedema Exudates Atrophy
60
Important things to note in retina
Retinal degeneration Breaks Haemorrhage Exudates
61
What must all examinations have
Assessment of vision Tonometry as glaucoma asymptomatic Thereafter tailor to Sx
62
If loss of vision
Need to dilate pupil as usually due to posterior issue
63
If suspect acute angle glaucoma
Goniosopy only way to exclude
64
What is medical emergency
Papilloedema | Enlarged and engorged
65
What is critical
CN examination

Ophthalmology (10 decks)

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