Ophthalmic History

Question 1

Presenting complaint

Answer 1

• Is vision affected?
  
  • Clarify - blurring/field loss/bits missing/wavy lines
  • Onset - sudden/gradual
  • Progression
• One of both eyes?
• Pain
  
  • SOCRATES
• Associated symptoms
  
  • Headache
  • Nausea and vomiting

Question 2

Red flags

Answer 2

• Floaters/flashing lights
• Haloes
• Headaches
  
  • Temporal
  • Jaw claudication
  • Worse with bending
• Repeated transient visual loss

Question 3

Past ocular history

Answer 3

• What is patients normal vision?
  
  • Glasses/contact lenses?
• Similar symptoms before?
  
  • Chronic conditions
• Any other eye conditions?
• Any previous eye operations?
  
  • Cataract surgery
  • Corneal graft
  • Glaucoma surgery

Question 4

PMHx

Answer 4

• Dermatological conditions
  
  • Seborrhoiec dermatitis
  • Atopic eczema
  • Rosacea
  • Psoriasis
• Hypertension
  
  • Retinopathy
  • Retinal vein occlusion
• DM
  
  • Retinopathy
  • Maculopathy
  • Retinal and vitreous haemorrhage
• Infections
  
  • Previous HSV
  • TB
  • HIV
  • CMV
• Inflammatory diseases
  
  • Ankylosing spondylitis
  • IBD
  • Sarcoidosis

Question 5

DHx

Answer 5

Question 6

SHx

Answer 6

• Smoker?
  
  • ARMD
  • Vascular
• Alcohol dependence?
  
  • Nutritional deficiencies
• Driver
  
  • DVLA guidelines

Question 7

Ophthalmic examination

Answer 7

• Visual acuity
• Pupils (PEARL? RAPD?)
• Visual fields
• Eye movements (9 cardinal points including primary position, any restriction, which muscles, diplopia at any position, nystagmus)
• External eye (lids, proptosis, conjunctiva)
• Slit lamp (for cornea)
• Ophthalmoscopy (check red light reflex, look at vessels/disc/macula)