clinic, history and symptoms possible causes of complaints

Question 1

gait and speech

Answer 1

-stroke
-neurological conditions e.g. parkinsons

Question 2

mobility issues

Answer 2

-bumping into things = visual field loss
-difficulty moving (arthritis)

Question 3

tilted/ turned head

Answer 3

-binocular vision problem
-extraocular muscle paresis

Question 4

facial or ocular appearance and asymmetry

Answer 4

-down’s syndrome
-stroke
-protruding/ sunken eye = orbital compression/ decompression
-anisocoria, palperable aperture size and shape which may indicate nerve damage, myasthenia gravis
-facial palsy

Question 5

skin condition/ colour

Answer 5

-papilloma
-carcinoma
-rashes
-vascular changes
-high blood pressure
-jaundice

Question 6

ethnicity

Answer 6

-glaucoma, sickle cell anaemia is more common in those of african decent
-presbyopia occurs 10 years earlier in races from warm climates

Question 7

weight/stature

Answer 7

-overweight = hypertension, raised cholesterol, type II diabetes
-tall = marfan’s syndrome

Question 8

vision is blurry

Answer 8

-one of the 4 refractive errors
-scratched glasses
-something stuck to CLs
-opacities in tears, cornea or internal eye
-something is affecting nerve pathways

Question 9

give some specific questions to ask about blur

Answer 9

-what distance is the blur, if they say both it could be pathology
-which eye?
-when did it start?
-when do you notice the blur?
-does anything make it go away?

Question 10

chronic vision loss

Answer 10

-corneal, lens or vitreous opacities
-retinal or macula disease
-glaucoma
-optic nerve disease or brain injury

Question 11

acute vision loss - EMERGENCY

Answer 11

-retinal detachment
-retinal or vitreous haemorrhage
-central retinal vein occlusion - blindness
-decreased VA or dimmed vision
-optic nerve disease/ brain injury

Question 12

Transient vision loss

Answer 12

-migraine
-transient ischaemic attack = impending stroke
-infection of cornea/ iris
-angle closure glaucoma

Question 13

what specific questions would you ask a patient with vision loss?

Answer 13

-which eye?
-when did it start?
-pain, redness or headache
-what does the vision loss look like? blur or totally black? scintillating? any shape to it?

Question 14

headache relating to vison

Answer 14

-uncorrected hyperopia
-astigmatism
-accommodative/ convergence problems

Question 15

headache relating to ocular pathology

Answer 15

-angle closure glaucoma
-optic neuritis
-iritis/ uveitis

Question 16

non-ocular pathology

Answer 16

-tension
-sinus
-migraine
-hypertension
-cluster
-increased intracranial pressure - EMERGENCY
-temporal arteritis

Question 17

what are the specific questions to ask for headache?

Answer 17

-onset, duration, frequency
-describe the pain: severe/ throbbing is a migraine
-where is the pain located
-when
-time of day? -hypertension worst when waking up
-associated with a particular activity
-associations, runny nose? = sinus / cold, tiredness/ loss of appetite = temporal arteritis
-nausea and aura = migraine
-what makes it go away? what seems to cause it?

Question 18

eyestrain?

Answer 18

-new Rx
-incorrect Rc
-induced prism in spectacles
-hyperopia
-astigmatism
-decompensated phoria
-accommodative/ convergence issues
-anisometropia

Question 19

what are the specific questions to ask for eyestrain?

Answer 19

-associated environmental conditions
-is it really eyestrain or is it headaches
-what alleviates the problem

Question 20

monocular diplopia

Answer 20

-uncorrected astigmatism
-poorly fitted contact lenses or contact lenses
-peripheral iris defect
-keratoconus
-sublaxation of the lens
-transparent foreign body
-opacity of the cornea or lens e.g. catarcat
-macular disease

Question 21

binocular diplopia

Answer 21

-accommodative/ convergence disorder
-strabismus of recent onset = diabetes, increased intracranial pressure, tumour, trauma
-displacement of the globe = orbital tumour, orbital cellulitis

Question 22

give specific questions to ask for diplopia

Answer 22

-constant or intermeittent
-one eye or both
-how are the images separated is it horizontal? vertical? diagonal?
-are the images completely seperate
-what distance
-associated with particular activities
-associated with other symptoms like pain
-history of diabetes/ trauma

Question 23

give specific questions to ask for strabismus

Answer 23

-recent or long time?
-family history?
-is it variable?
-associated symptoms?
-distance or near, or in certain positions of gaze?
-previous treatment like patching or eye exercises
-birth history especially use of forceps
-medications
-trauma

Question 24

red eye

Answer 24

-conjunctivitis
-pterygium
-keratitis
-uveitis
-angle closure glaucoma
-subconjunctival haemorrhage
-allergy
-trauma

Question 25

what specific questions do you ask a patient with red eye?

Answer 25

-intensity of pain?
-history of trauma
-itching, watering, runny nose = allergy
-pain? subconjunctival haemorrhage has no pain
-is vision affected
-any dischage? watery or mucopurulent? ask if eyelashes are stuck together on awakening to tell

Question 26

pain

Answer 26

-infection of the cornea, iris or orbit. orbital pain accompanied by nausea and swelling could be orbital cellulitis which is LIFE THREATENING
-foreign body or injury
-optic neuritis
-angle closure glaucoma

Question 27

give specific questions to ask for pain

Answer 27

-what does the pain feel like?
Burning, itching, scratching or pressure?
-is it superficial (foreign body) or deep? (corneal ulcers - uveitis, angle closure glaucoma)
-what makes it go away?
-what makes it worse?
-any fever?

Question 28

tearing

Answer 28

-interference with tear drainage from ectropian or blockage of the nasolacrimal duct
-inflammation of cornea, lids, sinuses, teeth
-allergy or chemical irritation
-eyestrain
-exposure to wind, cold, bright light
-dry eye
-problems with contact lens wear

Question 29

what questions do you ask a patient with tearing

Answer 29

-what is it associated with? VDU= blink less so eyes are drying out, aeroplane so dry air, offices due to heating and air con, contact lens wear
-any pain?
-any photophobia?
-medications?
-diabetes or trauma?