Ophthalmology Flashcards
what are the steps of an eye exam?
introduction inspection visual acuity colour vision extra ocular movements visual fields pupillary reflexes fundoscopy other tests; amsler chart, cranial nerve examination, blood pressure, capillary blood glucose, retinal photography
describe the examination of visual acuity
if the patient normally wears glasses, ensure these are worn for the exam
stand 6 metres from the Snellen chart
cover one eye
read to the lowest line they can read to
poor vision;
read using a pinhole to see if this improves vision; PH, refractive problem
reduce the distance to 3 metres
reduce the distance to 1 metres
counting fingers; CF
seeing gross hand movements; HM
detection of light from a pen torch; PL/NPL
describe the examination of extra ocular movements
hold your finger approximately 30cm away from the patient
ask them to keep their head still while following your finger
ask them if they experience any double vision or pain
observe for any restriction of eye movement or nystagmus
describe the examination of visual fields
sit about 1m across from the patient
cover one eye
focus on your nose and not move their head during the exam
ask the patient if any part of your face is missing/distorted
compare the patients visual field to your own and use the visual target
repeat for all visual quadrants of both eyes
describe the pupillary assessment
ask the patient to sit
dim the lights
shine the pen torch into one eye and assess for direct and then consensual reflex
swinging light test; move the pen torch rapidly between the two pupils
accommodation; ask the patient to look at a spot on the wall and place your finger in front of them and ask them to look at your finger then back again
what are you looking for during inspection of the eye?
peri-orbital regions; swelling, redness
eyelids; Horner’s syndrome
eyes; discharge, prominence
pupils; size, symmetry, shape, colour
describe fundoscopy
explain the process; close to patient, dilating drops
ask the patient to sit
dim the lights
red reflex; look at the patients pupils through the ophthalmoscope at one arms length
optic disc; colour, contour, cupping
retina
macula
what questions should be asked in the history of presenting complaint of an eye history?
the primary complaint one/both eye affected how the problem started pain visual disturbance red eye watery discharge grittiness/dryness itching photophobia swelling/tenderness trauma ideas, concerns and expectations
what questions should be asked in the PMHx of an eye history?
previous episodes any other eye problems/diagnosis previous eye trauma previous ocular surgery prescription glasses; near of far vision contact lenses; daily/monthly lenses, sleeps, showers, swims with lenses, hygiene regimen
allergies DM hypertension autoimmune conditions; SLE, RA atopy; asthma, allergic rhinitis, eczema
do you get your eyes tested annually?
what questions are related to visual disturbance?
one or both eyes affected
when did it begin
sudden or gradual onset
how severe is the disturbance
does anything make it worse or better
does it affect near or far vision or both
does it affect affect a specific area of vision
double vision
positive visual disturbances; flashing lights, floaters, black curtain, glare from low sun or headlights, halos around lights
visual distortions; wavy lines, sparkling shimmering lights, objects appearing smaller or larger
what questions are related to eye trauma?
mechanism; chemical, blunt, sharp
size, speed and nature of object
what questions should be asked in the FHx section of an eye history?
similar complaint glaucoma retinal detachment hypertension diabetes rheumatological disease
what rugs should be focussed on in the DHx section of an eye history?
lubricants antimicrobials corticosteroids glaucoma medications analgesics antihistamines
