Opthalmic history Flashcards
What are the most common presenting complaints in opthalmology?
- Change in Vision
- Red eye
- Pain / Discomfort
- Double vision
- Change in appearance of eye
What general aspects of a presenting complaint would you want to ask about?
- Unilateral / bilateral
- Time of onset
- Permanent / transient
- Relieving factors / precipitants
- Recovery
What specific things do you want to ask about in someone presenting with red eye?
- Change in vision?
- Pain?
- Discharge?
- Double vision?
- Headache?
What specific things would you want to ask about in someone who presented with a change in vision?
- Unilateral / Bilateral
- Onset: sudden / gradual (over which period of time)
-
Any recovery; If present:
- Back to normal
- Still affected – generally blurred / scotomas
- Pattern of recovery
- Transient (eg. better after blinking)/ Permanent
- Type of visual loss: Generally blurred/ Distorted
- Any associated symptoms (eg. pain, red eye, discharge)
What would you always want to ask about in someone with a change in vision?
Ask about amblyopia (lazy eye), especially if findings don’t correlate with level of vision
What key things would you want to ask about in someone presenting with pain/discomfort in their eye?
Exact nature of problem: proper pain, or just discomfort/gritty/ sore
Anything that makes it better/worse
Any associated problems
- Photophobia
- Headaches (eg. temporal headaches, jaw claudication)
- Pain around eyes (eg. sinusitis)
- Blocked nose
- Itching
When assessiing double vision, what is important to establish first?
Whether it is uniocular or binocular
What does uniocular diplopia point towards as a cause of diplopia?
Ocular conditions
What does binocular diplopia point towards as a cause of diplopia experienced by a patient?
Ocular motility/neurological problems
What factors would you ask about in someone with uniocular diplopia?
- Onset: sudden vs. gradual
- Relieving Factors (eq. lubricants, blinking)
- Any distortion? (suggests macular problem)
What are key factors to ask about in someone with binocular diplopia?
- Vertical / Horizontal
- Distance / Near / Both
- Sudden onset / Gradual onset
- Permanent / Transient
- Precipitants (eg. tiredness) / Relieving factors
- Important in this context: History of squint or squint Surgery; History of trauma; Associated Neurological symptoms / signs
If someone presented with a painful red eye with visual loss, what might this suggest as an underlying cause?
Inflammatory/infective cause
What would loss of vision in a white eye with no pain suggest as a cause of loss of vision?
- Acute - vascular event or retinal detachment
- Chronic - Gradual disease e.g. catarcts
When asking about past medical history, what are important previous medical problems which are important in the context of opthalmology?
Eczema/ asthma / hay fever – allergic eye disease
Cardiovascular risk factors e.g HTN, Diabetes, Hypercholesterolaemia, Previous strokes / MI: ischemic optic neuropathy, artery / vein occlusions/ III, IV, VI nerve palsies
Joints eg. ankylosing spondylitis, rheumatoid arthritis, juvenile idiopathic arthritis: Uveitis, scleritis, episcleritis
Exposure to infections (eg Lyme, TB, syphilis) – Uveitis
What are important aspects of the social history to ask about in an opthalmic history?
- Smoking – CV risk factors, AMD, Thyroid eye disease
- Alcohol – CV risk factors, Nutritional optic neuropathy
- Drugs – iv drug users – endogenous endophthalmitis
- High risk of STDs? – Uveitis (syphilis, HIV – CMV, HSV etc)
- Animals in house – Uveitis (toxoplasma, cat scratch disease); Allergic conjunctivitis
- Social context – Can they use drops? Can they take care of themselves?
- Are they a Driver?
