Lecture 21: Opthalmic eye disease, important hx

Question 1

What are some symptoms common to disease of the anterior eye?

Answer 1

— Grittiness, burning, itch, sharp pain,
watering, discharge, redness
— Blurred vision, photophobia

Question 2

What are some symptoms common to disease of the posterior eye?

Answer 2

— Loss of vision, distortion of vision
— Floaters, flashers, field defect
— Deep achey pain, redness

Question 3

What are symptoms common to disease of the orbit?

Answer 3

— Diplopia, ptosis, ache

Question 4

Redness + Ache + photophobia makes you think?

Answer 4

Uveitis

Question 5

Redness + Ache + Halo / blur makes you think?

Answer 5

Acute glaucoma

Question 6

Redness + Ache + Chemosis / lid swelling makes you think?

Answer 6

Orbital cellulitis

Question 7

Redness + Ache + ache at temple makes you think?

Answer 7

Giant cell arteritis and central retinal artery occulision

Question 8

What typically can cause photophobia?

Answer 8

— Keratitis
— or uveitis (anterior chamber inflammation
affecting pupil movement)
— Keep in mind meningitis

Question 9

What are the different types / causes of eye discharge?

Answer 9

• Purulent à Bacterial
• Mucopurulent à Chlamydia
• Mucoid à Allergic
• Watery à Viral

Question 10

What questions can you explore with ‘vision loss’?

Answer 10

• Sudden vs. gradual
• Intermittent vs. constant
• Unilateral vs. Bilateral
• Blur vs. field defect vs. complete blackness
• Field defect: central vs. peripheral
• Distortion: wavy lines
• Associated symptoms e.g. headache, haloes,
  pain

Question 11

What sorts of things can cause a transient vision loss?

Answer 11

• Few seconds à papilloedema,GCA
• Few mins à TIA
• 15-60 mins à migraine (+positive symptoms)

Question 12

What sorts of things can cause a sustained vision loss?

Answer 12

• Sudden painless -> retinal artery or vein occlusion,
  retinal detachment, vitreal haem
• Gradual painless -> cataract, refractive error, chronic
  retinal problem
• Painful -> angle closure glaucoma, optic neuritis,
  uveitis

Question 13

What are the possible causes of flashes and floaters?

Answer 13

• Flashes originate from stimulation of the
  neurosensory retina by traction from the vitreous
• Floaters due to degeneration of the vitreous
• Sudden onset suggest a posterior vitreous
  detachment.
• Large red/brown floaters or a drop in vision
  suggests vitreous haemorrhage

Question 14

What PMhx is important for the eyes?

Answer 14

• Vascular history if acute visual loss
• Rheumatological history in patients with uveitis
• Diabetes, hyperthyroidism
• Neurological problems; Myasthenia
• Previous Cancer
• Constitutional symptoms
• Polymylagia Rheumatica

Question 15

What FHx is important?

Answer 15

— Glaucoma
— Squint
— Poor vision
— Macular
Degeneration
— Keratoconus
— Retinal
Detachment