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Ophthalmology > Ophthalmic Hx and Examination > Flashcards

Ophthalmic Hx and Examination Flashcards

1
Q

What is important in the history of eye issue

A 
MUST rule out emergencies 
Uni or bilateral
Time of onset
Permanent or transient
Relieving factors and precipitants
Normal baseline 
Recovery - full or partial
Associated Sx
Associated conditions - HTN / DM
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2
Q

What do you want to know about red eye

A 
Change in vision
Pain
- What is it like
- How long for and when does it happen 
Any other Sx or associated features 
Discharge
Double vision
Any floaters / halo 
Headache
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3
Q

What do you want to know about change in vision

A 
Uni or bilateral
Sudden or gradual 
Recovery
Transient - i.e. better after blinking or permanent 
Type of loss - blurred/ tunnel
PAINFUL OR PAINLESS 
Associated Sx - pain / red / discharge
Any amblyopia
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4
Q

What do you want to know about pain

A

Is it painful or just discomfort / grit
Ocular surface pain (blepharitis, conjunctivitis, keratitis, ulcer, dry eyes)
- Gritty
- FB sensation
- Sharp
Internal ocular (uveitis / scleritis / glaucoma)
- Throbbing
- Dull ache
Pain on movement
- Optic neuritis
- Scleritis
Anything that makes it better - painkiller / eyedrops
Anything that makes it worse - light / movemnt
Associated Sx

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5
Q

What associated Sx

A 
Visual disturbance 
Diplopia 
Distortion 
Photophobia
Headache
Pain within eye 
Pain around eye - sinusitis
Floaters 
Trauma to eye 
Discharge- watery vs pus 
Dry eyes 
Blocked nose
itch
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6
Q

What do you want to know about discharge

A 
Colour 
Type
Constant or intermittent
Acute or chronic
Itch
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7
Q

What do you want to know about double vision

A

Uniocular (present when covering one eye)

Binocular (relieved covering one eye)

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8
Q

What does uniocular suggest

A

Ocular issue

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9
Q

What do you want to know

A

Onset
Releiving factor
Distortion which suggests macular cause

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10
Q

What does binocular suggest

A

Neuro problem e.g. cerebral artery aneurysm

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11
Q

What do you want to know

A 
Vertical or horizontal
Sudden or gradual
Permanent or transient
Precipitants
Relieving 
Associated neuro
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12
Q

What is important in past ophthalmic Hx

A 
Has it happened before
Eye surgery
- Strabimus
- Cataract
- Laser 
Contact lenses use 
- Last assessment, how long and how cleaned 
Ambylopia in childhood
Any trauma
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13
Q

What is important in PMH

A 
HTN or DM 
Atopy
CVS RF
Joints
Bowels for IBD 
Exposure to infections - any sinus infections
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14
Q

What is important in social HX

A 
Recent travel 
Smoking
Alcohol
Drugs
STI
Animals
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15
Q

What do you look for in inspection

A 
Facial asymmetry
Rash
Lid position
Globe abnormality
Pupil asymmetry
Any lumps / red / discharge
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16
Q

What are types of lid position

A

Ptosis - dropping
Entropion = inverted so lashes can rub against eye
Ectropian = everted + droopy

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17
Q

What are globe abnormalities

A 
Proptosis = forward
Enopthalmos = posterior
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18
Q

What is acute red eye typically affecting

A

Anterior segment

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19
Q

What does visual loss tend to affect

A

Posterior segment

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20
Q

What is the best way to examine eye

A

Front to back
Assess vision
Assess anterior segment
Assess posterior segment

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21
Q

How do you examine

A 
General inspection 
Visual acuity
Colour vision
Pupils 
Slit lamp
Fundoscopy - optic nerve 
Optic nerve
Ocular movement
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22
Q

What do you need

A

Snellen chart
Opthamloscope
Slit lamp

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23
Q

How do you assess visual acuity

A

Visual acuity with Snellen chart

  • Do each eye separate
  • Wear glasses
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24
Q

What should you do if vision reduced

A

Ask to look through pinhole

This will correct refractive error

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25
Q

What is used to assess visual field

A

Using fingers will only show gross defect
If suspect need to refer for formal testing
Perimetry
Field Analyers will change colour for defects
Used to asses neuro / glaucoma - peripheral

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26
Q

What will macular hole cause

A

Central loss or distortion

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27
Q

What will retinal detachment cause

A

Peripheral field defect

28
Q

What does a monocular defect suggest

A

Problem in that eye or optic nerve to chiasm

After dicussation any lesion will cause defect in both eyes

29
Q

Optic nerve disease

A

Central scrotoma

30
Q

How does retinal disease present

A

Causes defect in opposite half of visual field
A large scar in inferior retina will cause a superior field defect
Inferior branch retinal vein occlusion = monocular superior loss

31
Q

When is colour vision common reduced

A

Optic nerve centrally

Peripherally with chiasm

32
Q

What happens in particular

A

Red desaturation

33
Q

What is used to test

A

Colour plates

Use for all suspected optic nerve / neurological disease

34
Q

When is colour normal

A

Glaucoma

35
Q

How do you assess pupils

A

Ask to fixate on distant target
- Are pupils normal sizes and equal

Reduce light
- Are pupils still equal

Check light response

  • Shine light in one eye and check direct resposne
  • Check the consensual response

Accommodation

  • Ask to fixate on distant object
  • Introduce a new object close and ask them to focus
36
Q

How do you assess eye movement

A 
Is there diplopia in primary position 
Ask patient to follow a target
Ask if they have any double vision 
Ensure not monocular by getting them to cover one eye and making sure it disappears
Describe orientation of diplopia
37
Q

What commonly causes horizontal diplopia

A

6th nerve palsy

Decompensated horizontal squint

38
Q

What commonly causes tilted / vertical

A

4th nerve palsy

39
Q

Diplopia + ptosis

A

3rd nerve palsy

EMERGENCY

40
Q

If doesn’t fit CN pattern

A

Supranuclear or localised ocular

41
Q

What do you look for in slit lamp examination

A

Anterior segment

  • Conjunctiva
  • Cornea
  • Iris
HYphaema = blood in AC 
Hypopyan = pus in AC
42
Q

What do you look for with conjunctiva

A 
Any discharge
Does it look bumpy
- Allergy
- Viral conjunctivitis 
Any hyperaemia
- Episcleritis - superficial 
- Scleritis - deep 
- Uveitis
- Blepharitis - at lid margins
43
Q

What do you look with cornea

A 
Clear vs hazy 
Hazy due to corneal oedema 
Corneal ulcer = local opacity only 
Swelling
White area in red eye indicates stoma infiltrate in keratitis 
Add flurosecin
44
Q

What does fluroscein do

A

Looks for epithelial defect

  • Dendritic ulcer
  • Infection / abrasion
45
Q

If painful post corneal transplant

A

Senior help

- Could be infection or rejection

46
Q

What is the anterior chamber

A

Area between cornea and iris

47
Q

What do you look at in anterior chamber

A

Is anterior chamber normal depth or shallow
- If shallow need to exclude an occludable angle with gongioscopy as cause glaucoma

Can you see light in anterior chamber

  • No usually appears empty and only see light shone on cornea and iris
  • Suggests inflammation or infection
48
Q

Iris

A

Is colour the same in both eyes
Is it stuck to lens - synechiae (makes pupil irregular and sign of inflammation)
Any iris transillumination defects

49
Q

What is tonometry used for

A

Measure IOP

Too thick fluroscein can underestimate

50
Q

What is gonioscopy

A

Examine angle
Better in dark
Cannot exclude an occluded angle without performing

51
Q

What does posterior segment involve

A

Dilating pupil - essential to see behind the lens
Lens
Vitreous
Fundoscopy

52
Q

Before dilating pupil what should you check

A

No driving as will blur eye
Ensure pupil response checked as won’t be able to for 24 hours
May be only +Ve sign in optic neuritis

53
Q

What do you use to dilate

A

Tropicamide - fasted acting

Phenylephrine

54
Q

Most common cause of gradual vision loss

A

Cataract

55
Q

What do you look for in the lens

A

Lens opacities - sign of cataract
Loose len zonules - blunt trauma
Dislocated lens (not in centre) - causes astigmatism
Artificial lens implant after cataract

56
Q

What do you look for in vitreous (usually clear)

A

Dust
White cells - vitritis
Red cells - haemorrhage

57
Q

What do you do in fundoscopy with opthamolscope

A 
Check red red reflex 
Look optic disc
Assess vessels radiating
Look at macula
Look in all 4 peripheral quadrants of retina
58
Q

Important things to note in disc

A

Swelling
CUpping
Abnormal vessels

59
Q

Important things to note with macula

A

Haemorrhage
Oedema
Exudates
Atrophy

60
Q

Important things to note in retina

A

Retinal degeneration
Breaks
Haemorrhage
Exudates

61
Q

What must all examinations have

A

Assessment of vision
Tonometry as glaucoma asymptomatic
Thereafter tailor to Sx

62
Q

If loss of vision

A

Need to dilate pupil as usually due to posterior issue

63
Q

If suspect acute angle glaucoma

A

Goniosopy only way to exclude

64
Q

What is medical emergency

A

Papilloedema

Enlarged and engorged

65
Q

What is critical

A

CN examination

Ophthalmology (10 decks)

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