eye👁️

Question 1

history to ask

Answer 1

eye pain- pain only on movement or?
headache
fever
vision loss- trauma, bacterial keratitis
blurring of vision
halo around light
glare
photophobia
any trauma?
opthal procedure?
dry eyes
contact lens
redness
swelling
haziness- endophthalmitis
discharge- watery/purulent
crusting in the morning
contact history
if suspecting allergic conjunctivitis- atopy!!

Question 2

ddx to consider in primary care?

Answer 2

• ① Bilateral
  
  • Infective conjunctivitis
    
    • Acute history of bilateral red eyes
    • only mild discomfort
    • otherwise well patient
    • full visual acuity
    • ± discharge — purulent in bacterial conjunctivitis, watery in viral conjunctivitis
    • ± ‘stuck shut’ with crusting in the morning
    • often 1 eye affected first → spread to the other eye
    • positive contact history
  • Allergic conjunctivitis
    
    • Pruritic, watering eyes
    • atopy — rhinitis, asthma, eczema
    • minimal discharge — pruritus is more severe
    • both eyes turn red at the same time
  • Dry eyes (keratoconjunctivitis sicca)
    
    • Mild erythema and discomfort
    • worse on visual strain (reading)
    • If severe, consider a secondary cause of dry eyes ie Sjogren’s syndrome
• ② Unilateral
  
  • Infective Conjunctivitis
  • Sub-conjunctival haemorrhage
    
    • well patient
    • Sudden appearance
    • well-demarcated haemorrhage
    • spontaneous or a/w coughing, sneezing or straining (which increases intraocular pressure)
    • no discharge
    • harmless
  • Episcleritis
    
    • Mild irritation and sectorial (or diffuse) vascular congestion
    • self-limiting
  • Preseptal cellulitis
    
    • An erythematous and swollen eyelid
    • ascending spread of infection from sinusitis
    <aside>
    📌 ‼️ Distinguish from 🚩 orbital cellulitis red flags of
    ① chemosis
    ② visual loss
    ③ ophthalmoplegia
    4. toxicity
    </aside>

Question 3

dx to consider

Answer 3

sjogren for dry eyes
TIA for transient visual loss (amaurosis fugax)
pain may indicate optic nerve/optic disc pathology
brain lesion for visual loss
migraine

Question 4

chronic visual loss (important ddx for primary care)

Answer 4

1. refractive errors- visual acuity improves with pinhole
2. cataract- glaring when they look at light, haziness, starbursts around light. more in old age, DM, steroids. mx: surgical
3. glaucoma- progressive, tunnel vision, increased cup to disc ratio (>0.6), ix: measure intraocular pressure
4. age related macular degeneration- poor central vision, fundoscopy shows macular neovasc, exudates or hemorrhage
5. diabetic retinopathy- visual loss, may progress to retinal detachment. fundoscopy: hemorrhages, exudates, macular edema, neovasc
6. corneal blindness- keratitis leading to opacity
7. drug toxicity- hydroxychloroquine & ethambutol!!!! (TB drugs)