Competency 1.1.1 and 1.1.2 Flashcards
Notes on General Observation of Patient
- Thin – overactive thyroid
- Overweight – HBP or DM
- Abnormal head position (AHP) – problem with ocular motility
- Facial asymmetry – congential anomalies
- Speech, intelligence and emotional state affects choice of test
Location in LOFTSEA
- If CC is headache (H/A) ask, “where does it hurt?”
- If CC is blurred vision, ask, “are both eyes affected or just one?”
- If CC is diplopia, ask, “does this happen when you are looking in any particular direction?”
Onset in LOFTSEA
- Ask, “when did this start happening?”
- Ask, “did it occur suddenly or gradually?”
- can indicate pathology if sudden (e.g. central retinal occlusion),
- due to Rx if gradual, but can also be pathological (e.g. cataract)
- Long onset may imply problem is not having severe effect on Px
Frequency in LOFTSEA
Ask, “how often does this happen?” or “how long does it last?” If problem is of visual origin then they tend to occur:
- When using eyes (reading, watching TV, driving)
- During weekdays more than weekends
- Start in the middle of the day and gradually get worse
Type in LOFTSEA
- If CC is H/A ask, “is it a throbbing, sharp or dull headache?”
- If CC is blurred vision, ask “is the blur constant or intermittent?” or “was the vision loss partial or total?”
- If it is intermittent it could be due to: tear film disfunction or fluctuating blood sugar levels (diabetes)
- If a constant blur it could be due to Rx or pathology
- If CC is diplopia, ask:
- “Is the double vision one-on-top-of-the- other or side-by-side?”
- or “does the double vision disappear when one eye is closed?”
Constant DV Blur Causes
- Myopia which is gradually onset form ages around 10 to 18 years. It can cause HA and eye squinting to see better.
- Nuclear sclerosis is a type of cataract which affects the centre of the lens which leads to an increase in refractive index, inducing a myopic shift.
Intermittent DV Blur Causes
- (Young?) diabetics due to variable myopia
- Pseudomyopia occurs when individuals are not able to relax their accommodation after periods of near work. This can be caused by poorly controlled diabetes.
Intermittent NV Blur Causes
- Presbyopes often find near vision is ok with good lighting (smaller pupil gives larger depth of focus)
DV and NV Blur
- Astigmatism
- Pathology e.g cataract or maculopathy
Caused of Asthenopia
Causes include:
- Ametropia (most often hypermetropia)
- Accommodative dysfunction
- Presbyopia
- Binocular anomaly
- Poor illumination
Pathological causes include:
- Ocular inflammation
Characteristics of a Migraine
- Unilateral or Bilaterial
- Pulsating pain
- Moderate to severe
- Causes avoidance of physical activity
- Last hours to days
- 1 or 2 attacks per month
- Associated symptoms:
- Nausea/vomiting
- Photophobia
Characteristics of Tension Headache
- Bilateral
- Pressing or tightening (not pulsating)
- Mild or moderate severity
- No aggravation by physical activity
- Attacks last hours to days
- No associated symptoms
Characteristics of Cluster Headache
- Unilateral
- Very severe
- No aggravation by physical activity
- Attacks last from 15 mins to 3 hrs
- 1 to 3 attacks per day
- Usually daily for 3 months at a time
- Associated symptoms:
- Conjunctival injection
- Lacrimation
- Nasal congestion
- Restlessness
Characteristics of Vision Related Headaches
- Associated with use of eyes
- Mild to moderate in severity
- Located above or behind eyes but occasionally temporal or occipital
Questions Relating to Spectacle Wear
- At what age did you start wearing spectacles
- Identify type of specs (SVD, SVN, VAR etc.)
- What are they used for?
- How often are they used?
- How old are they?
- Are you happy with these?
Questions Relating to Contact Lens Wear
- When did you first start wearing contact lenses?
- What type of lenses do you wear? (material, modality, type)
- How old are they? (if e.g. monthly)
- How often do you wear these?
- What is your care regime? (if applicable)
- Are you happy with these?
Questions Relating to Previous Eye Treatment
Any HES treatement or referral? If patient has been seen at HES then ask:
- What were you treated for?
- How long ago was this?
- Where did you have this treatment?
- Are you still having this treatement? If yes then when is next appointment
Questions Relating to DM and HBP
- How long have you had this?
- Who is treating you?
- When was your last check-up?
- When is your next check-up?
Questions Relating to Medications
- Name of medication
- Dosage
- How often taken
- When medication was started/duration of treatment
Questions Relating to Young Patient Birth History
- Birth weight
- FT or premature
- Oxygen given at birth?
- Delivery method
- Forecept use?
Questions Relating to Family General Health Issues
- Condition and type
- When it was onset
- Treatment
- Any affect on eyes
Strabismus and Family Links
The prevalence of strabismus increases:
- 10% if one parent has strabismus
- 40% if both parents have strabismus
- Upto 30% of people with strabismus have a close relative with strabismus
