Ophthalmic history | Flashcards
In a patient who presents with a red eye, what 6 questions should you ask?
- Past ocular history
- Nature of discomfort
- Discharge
- Uni/bilateral
- Vision
- General medical history
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?
- Recurrent disease?
- iritis
- herpes simplex keratitis - Hypermetropia and acute glaucoma?
- Contact lens use?
- corneal abrasion or ulceration
In a patient with a red eye, what would you ask about as the nature of the discomfort and what would it suggest (4)?
- Itching
- allergic conjunctivitis - Grittiness
- infective conjunctivitis - Pain
- suggests more serious disease - Photophobia, pain on reading
- iritis
In a patient with red eye, what would you ask about for discharge and what would it suggest (3)?
- Watery discharge?
- viral conjunctivitis and corneal epithelial defects (including abrasions) - Purulent
- bacterial, chlamydial conjunctivitis - Mucoid
- allergic conjunctivitis
In a patient with red eye, what would a unilateral or bilateral eye suggest (2)?
- Unilateral
- infection is initially unilateral, but usually becomes bilateral
- iritis, acute glaucoma, almost always unilateral - Bilateral
- allergy is almost always bilateral
What can the nature of vision loss with red eye indicate (2)?
- Minimal or transient blurring can be caused by watering and discharge alone
- Persistent significant visual loss indicates more serious disease
In a patient with red eye, what other factors in the general medical history could be asked about and what would they indicate (4)?
- URTI
- infective conjunctivitis - History of allergy or atopy
- Systemic associations:
- Iritis and sarcoidosis
- ankylosing spondylitis
- scleritis and connective tissue disease - Rosacea and blepharoconjunctivitis
What would you ask in a patient with gradual vision loss (over days/weeks/months) (4)?
- Past ocular history
- General medical history
- Family history
- Worse for distance or near?
In a patient with gradual vision loss, what specific questions regarding past ocular history would you ask about and what would they indicate (2)?
- Other ocular diseases
- many predispose to cataract - Topical medication, especially steroids
- cataract, glaucoma
In a patient with gradual vision loss, what specific questions regarding general medical history would you ask about and what would they indicate (6)?
- DM
- retinopathy/cataract - Atopy
- cataract - Medication:
- Steroids: cataract, glaucoma
- Chloroquine and tamoxifen (toxic retinopathy) - Recent sight test (refraction)
- Exclude an uncorrected refractive error - Trauma?
- Can lead to cataract, glaucoma and retinal detachment - History of amblyopia (lazy eye)
In a patient with gradual vision loss, what specific questions regarding family history would you ask about and what would they indicate (3)?
- Glaucoma
- Hereditary optic nerve, corneal or retinal disease
- Early onset cataract
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)?
- Worse for near suggests macular disease or posterior subcapsular cataract
- Worse for distance suggests nuclear sclerotic cataract
What would you ask in a patient with sudden vision loss (immediate/over minutes/over hours) (5)?
- Onset (very sudden, recurrent?)
- Quality of visual loss
- Area of visual field affected
- Associated ocular symptoms
- General medical history
In a patient with sudden vision loss, what specific questions regarding onset would you ask about and what would they indicate?
(3)
- Very sudden onset
- arterial vascular aetiology - Recurrent transient loss
- embolic episodes
- consider also migraine, ischaemic optic neuropathy (including giant cell arteritis), raised ICP - Uncertain onset but suddenly noticed
- retinal vein occlusion
- macular haemorrhage
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)?
- Profound loss of vision
- Arterial occlusion - Blurring
- most other conditions, not arterial occlusion - Distortion
- macular disease
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)?
- Central only
- macular diseases - Loss of left or right field
- hemianopia - Progression from periphery to centre
- Retinal detachment
- Retinal artery embolism
- Migraine
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)?
- Pain and red eye:
- acute glaucoma - Headache, nausea, coloured dots, cracked glass effect (scintillating scotomata):
- migraine - Pain on eye movement:
- consideroptic neuritis
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 comprehensive vascular history is essential
- Headache, jaw claudication, transient visual loss:
- exclude giant cell arteritis - Neurological disease:
- migraine, demyelination
What would you ask in a patient with double vision (diplopia) (5)?
- Check diplopia is binocular
- Position of images
- Intermittent
- History of trauma
- General medical history
In a patient with diplopia, what specific questions regarding whether diplopia is binocular or not and what would it indicate (2)?
- Binocular - two clear images present when both eyes open, cured by covering either eye:
- indicates ocular misalignment (strabismus) - Monocular ‘diplopia’:
- usually cataract
In a patient with diplopia, what specific questions regarding position of images would you ask and what would it indicate (2)?
- Side by side:
- Usually 6th nerve palsy - Vertical or diagonal:
- any other cause of strabismus
In a patient with diplopia that is intermittent, what would it indicate?
Decompensating latent strabismus
-myasthenia gravis or dysthyroid eye disease
In a patient with diplopia, what specific questions regarding history of trauma would you ask (2)?
- 4th nerve palsy
2. Orbital fracture
In a patient with diplopia, what specific questions regarding general medical history would you ask and what would it indicate (2)?
- Take a comprehensive vascular history
2. Consider symptoms of thyroid dysfunction, raised ICP, myasthenia gravis
