Eye history Flashcards
How would you structure the presenting complain?
- primary complaint, one or both eyes, how it started
- Exploring visual disturbances
- Exploring eye pain
- Exploring eye redness
- Exploring dryness
- Photophobia
- Swelling or tenderness
What are ocular red flags?
- Eye pain
- Photophobia
- Visual disturbances
- Red eye
- Trauma
How would you explore visual disturbances?
SOCRATES + double vision + visual distortions
What can cause transient visual loss (less than 24 hours)?
- Migraine: marching sparkling shimmering lights <60 minutes – both eyes but typically only one hemifield
- Amaurosis fugax: profound loss of vision in one eye lasting minutes to hours. Caused by vascular disease/vasculitis
- Papilloedema: a complete brief loss of vision (obscurations), which may be unilateral or bilateral
What can cause persistent visual loss (more than 24 hours)?
- Retinal vein or artery occlusion
- Anterior ischaemic optic neuropathy (e.g. temporal arteritis)
- Stroke affecting the visual pathways
- Vitreous haemorrhage
- Wet age-related macular degeneration
- Retinal detachment
What can cause gradual painless loss of vision?
- Cataract
- Refractive error
- Dry age-related macular degeneration (AMD)
- Open-angle glaucoma
- Tumours affecting the visual pathway
- Nutritional optic neuropathy
What can cause painful loss of vision?
- Acute closed-angle glaucoma
- Optic neuritis
- Anterior ischaemic optic neuropathy
- Uveitis
- Keratitis
- Endophthalmitis
Based on location of eye pain, what is the most likely diagnosis?
- Under the eyelid (e.g. foreign body)
- Within the eyeball itself (e.g. acute glaucoma)
- Behind the eye (e.g. optic neuritis)
- A frontal headache that radiates around the eyes (e.g. migraine)
What would you ask about the onset of the eye pain?
“How did the pain start?”
“Did the pain come on suddenly or gradually?”
“What were you doing when the pain started?”
“Did the pain wake you from sleep?”
What would you ask about the character of the eye pain?
“How would you describe the pain?” (e.g. dull ache, throbbing, sharp)
“Is the pain worse when you move the eye?”
“Does it feel like you’ve got something in the eye?”
“Does the eye feel gritty?”
What would you ask about the radiation of the eye pain?
“Does the pain spread elsewhere?”
What would you ask about the associated factors of the eye pain?
Nausea/vomiting (e.g. acute glaucoma) Unilateral headache (e.g. migraine with aura) Visual disturbance Red eye Discharge or watering Grittiness or dryness Itching Photophobia Swelling
What would you ask about the time course of the eye pain?
“How has the pain changed over time?”
“Does the pain come and go?”
“Do you feel the pain is getting worse over time?
What would you ask about the exacerbating or reliving factors of the eye pain?
“Does anything make the pain worse?” (e.g. blinking, touching the eye, moving the eye, bright light)
“Does anything make the pain better?” (e.g. analgesia, cool water, warm compress, removing contact lenses, dimming the lights)
What systemic enquiry would you do for an ocular history?
Systemic: fevers, weight loss, malaise (e.g. temporal arteritis)
Cardiovascular: chest pain (e.g. pericarditis/myocarditis in autoimmune conditions), scalp pain and jaw claudication (e.g. temporal arteritis)
Respiratory: dyspnoea, cough, pleuritic chest pain (e.g. pleuritis in autoimmune conditions)
Gastrointestinal: nausea/vomiting (e.g. acute-angle-closure glaucoma), diarrhoea (e.g. ulcerative colitis)
Genitourinary: dysuria, discharge, bleeding, pelvic pain (e.g. chlamydia, gonorrhoea)
Neurological: headache (e.g migraine, hypertension, raised intracranial pressure, temporal arteritis), weakness, ataxia and sensory disturbances (e.g. multiple sclerosis, diabetes, stroke)
Musculoskeletal: joint pain/stiffness (e.g. rheumatoid arthritis, ankylosing spondylitis), myalgia (e.g. polymyalgia rheumatica)
Dermatological: rashes (e.g eczema, psoriasis, rosacea), butterfly rash (e.g. SLE)
Endocrine: polyuria/polydipsia (e.g. diabetes mellitus), feeling hot (e.g. hyperthyroidism)
