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Ophthalmology > Ophthalmic history | > Flashcards

Ophthalmic history | Flashcards

1
Q

In a patient who presents with a red eye, what 6 questions should you ask?

A
  1. Past ocular history
  2. Nature of discomfort
  3. Discharge
  4. Uni/bilateral
  5. Vision
  6. General medical history
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2
Q

In a patient with a red eye, what would you ask in the past ocular history to help you with the diagnosis (3)? What diagnoses would they indicate?

A
  1. Recurrent disease?
    - iritis
    - herpes simplex keratitis
  2. Hypermetropia and acute glaucoma?
  3. Contact lens use?
    - corneal abrasion or ulceration
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3
Q

In a patient with a red eye, what would you ask about as the nature of the discomfort and what would it suggest (4)?

A
  1. Itching
    - allergic conjunctivitis
  2. Grittiness
    - infective conjunctivitis
  3. Pain
    - suggests more serious disease
  4. Photophobia, pain on reading
    - iritis
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4
Q

In a patient with red eye, what would you ask about for discharge and what would it suggest (3)?

A
  1. Watery discharge?
    - viral conjunctivitis and corneal epithelial defects (including abrasions)
  2. Purulent
    - bacterial, chlamydial conjunctivitis
  3. Mucoid
    - allergic conjunctivitis
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5
Q

In a patient with red eye, what would a unilateral or bilateral eye suggest (2)?

A
  1. Unilateral
    - infection is initially unilateral, but usually becomes bilateral
    - iritis, acute glaucoma, almost always unilateral
  2. Bilateral
    - allergy is almost always bilateral
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6
Q

What can the nature of vision loss with red eye indicate (2)?

A
  1. Minimal or transient blurring can be caused by watering and discharge alone
  2. Persistent significant visual loss indicates more serious disease
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7
Q

In a patient with red eye, what other factors in the general medical history could be asked about and what would they indicate (4)?

A
  1. URTI
    - infective conjunctivitis
  2. History of allergy or atopy
  3. Systemic associations:
    - Iritis and sarcoidosis
    - ankylosing spondylitis
    - scleritis and connective tissue disease
  4. Rosacea and blepharoconjunctivitis
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8
Q

What would you ask in a patient with gradual vision loss (over days/weeks/months) (4)?

A
  1. Past ocular history
  2. General medical history
  3. Family history
  4. Worse for distance or near?
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9
Q

In a patient with gradual vision loss, what specific questions regarding past ocular history would you ask about and what would they indicate (2)?

A
  1. Other ocular diseases
    - many predispose to cataract
  2. Topical medication, especially steroids
    - cataract, glaucoma
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10
Q

In a patient with gradual vision loss, what specific questions regarding general medical history would you ask about and what would they indicate (6)?

A
  1. DM
    - retinopathy/cataract
  2. Atopy
    - cataract
  3. Medication:
    - Steroids: cataract, glaucoma
    - Chloroquine and tamoxifen (toxic retinopathy)
  4. Recent sight test (refraction)
    - Exclude an uncorrected refractive error
  5. Trauma?
    - Can lead to cataract, glaucoma and retinal detachment
  6. History of amblyopia (lazy eye)
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11
Q

In a patient with gradual vision loss, what specific questions regarding family history would you ask about and what would they indicate (3)?

A
  1. Glaucoma
  2. Hereditary optic nerve, corneal or retinal disease
  3. Early onset cataract
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12
Q

In a patient with gradual vision loss, what specific questions regarding loss of distant/near vision would you ask about and what would they indicate (2)?

A
  1. Worse for near suggests macular disease or posterior subcapsular cataract
  2. Worse for distance suggests nuclear sclerotic cataract
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13
Q

What would you ask in a patient with sudden vision loss (immediate/over minutes/over hours) (5)?

A
  1. Onset (very sudden, recurrent?)
  2. Quality of visual loss
  3. Area of visual field affected
  4. Associated ocular symptoms
  5. General medical history
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14
Q

In a patient with sudden vision loss, what specific questions regarding onset would you ask about and what would they indicate?

(3)

A
  1. Very sudden onset
    - arterial vascular aetiology
  2. Recurrent transient loss
    - embolic episodes
    - consider also migraine, ischaemic optic neuropathy (including giant cell arteritis), raised ICP
  3. Uncertain onset but suddenly noticed
    - retinal vein occlusion
    - macular haemorrhage
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15
Q

In a patient with sudden vision loss, what specific questions regarding quality of visual loss would you ask about and what would they indicate (3)?

A
  1. Profound loss of vision
    - Arterial occlusion
  2. Blurring
    - most other conditions, not arterial occlusion
  3. Distortion
    - macular disease
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16
Q

In a patient with sudden vision loss, what specific questions regarding areas of visual field affected would you ask about and what would they indicate (3)?

A
  1. Central only
    - macular diseases
  2. Loss of left or right field
    - hemianopia
  3. Progression from periphery to centre
    - Retinal detachment
    - Retinal artery embolism
    - Migraine
17
Q

In a patient with sudden vision loss, what specific questions regarding associated ocular symptoms affected would you ask about and what would they indicate (3)?

A
  1. Pain and red eye:
    - acute glaucoma
  2. Headache, nausea, coloured dots, cracked glass effect (scintillating scotomata):
    - migraine
  3. Pain on eye movement:
    - consideroptic neuritis
18
Q

In a patient with sudden vision loss, what specific questions regarding general medical history affected would you ask about and what would they indicate (3)?

A
  1. A comprehensive vascular history is essential
  2. Headache, jaw claudication, transient visual loss:
    - exclude giant cell arteritis
  3. Neurological disease:
    - migraine, demyelination
19
Q

What would you ask in a patient with double vision (diplopia) (5)?

A
  1. Check diplopia is binocular
  2. Position of images
  3. Intermittent
  4. History of trauma
  5. General medical history
20
Q

In a patient with diplopia, what specific questions regarding whether diplopia is binocular or not and what would it indicate (2)?

A
  1. Binocular - two clear images present when both eyes open, cured by covering either eye:
    - indicates ocular misalignment (strabismus)
  2. Monocular ‘diplopia’:
    - usually cataract
21
Q

In a patient with diplopia, what specific questions regarding position of images would you ask and what would it indicate (2)?

A
  1. Side by side:
    - Usually 6th nerve palsy
  2. Vertical or diagonal:
    - any other cause of strabismus
22
Q

In a patient with diplopia that is intermittent, what would it indicate?

A

Decompensating latent strabismus

-myasthenia gravis or dysthyroid eye disease

23
Q

In a patient with diplopia, what specific questions regarding history of trauma would you ask (2)?

A
  1. 4th nerve palsy

2. Orbital fracture

24
Q

In a patient with diplopia, what specific questions regarding general medical history would you ask and what would it indicate (2)?

A
  1. Take a comprehensive vascular history

2. Consider symptoms of thyroid dysfunction, raised ICP, myasthenia gravis

25
Q

What questions regarding social history would you ask about in an ophthalmic history (2)?

A
  1. Smoking and alcohol
  2. Knowledge of the patient’s social situation (especially for elderly and also suitability for surgery)
    - Indicators of function, such as reading, crossing the road and shopping
    - consider arrangements for surgery e.g. suitability for day case surgery
26
Q

What causes floaters of the eye?

What group of people are more likely to get it?

A

Caused by vitreous degeneration

Predominantly occurs in the elderly and myopes

27
Q

What does sudden onset floaters indicate?

A

acute posterior vitreous detachment: consider impending retinal detachment

28
Q

What does sudden onset floaters associated with a reduction in vision indicate?

A

Consider vitreous haemorrhage

29
Q

What do floaters associated with inflammatory cells in the vitreous indicate (2)?

A
  1. Posterior uveitis

2. Rarely iritis

30
Q

What do transient flashing lights, associated with head or eye movement indicate?

A

Acute posterior vitreous detachment

31
Q

What do recurrent flashing lights for several minutes, often in a ‘zig-zag’ pattern indicate?

A

consider migraine

32
Q

What should you ask about with regards to the past ocular history in a patient with floaters or flashing lights?

A

Myopia: consider vitreous detachment, susceptible to retinal detachment

33
Q

What should you ask about with regards to general medical history in a patient with floaters or flashing lights (3)?

A
  1. Diabetic retinopathy as a cause of vitreous haemorrhage
  2. Migraine
  3. Causes of iritis and posterior uveitis

Ophthalmology (12 decks)

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