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    Ophthalmology IV Symptoms of Eye Disease

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    Charlie Cheng-Ying Hsieh
    The document outlines important factors to consider when taking a patient's history for eye symptoms and disease. It discusses obtaining details on the presenting complaint, symptom characteristics, associated symptoms, pain characteristics, vision changes, discharges, and considering the patient's medical, ocular, family, and social history to properly diagnose the condition. A thorough history guides the clinical exam and investigations, and places the problem in the full context of the patient.

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    Ophthalmology IV Symptoms of Eye Disease

    Uploaded by

    Charlie Cheng-Ying Hsieh
    64 views23 pages
    The document outlines important factors to consider when taking a patient's history for eye symptoms and disease. It discusses obtaining details on the presenting complaint, symptom characteristics, associated symptoms, pain characteristics, vision changes, discharges, and considering the patient's medical, ocular, family, and social history to properly diagnose the condition. A thorough history guides the clinical exam and investigations, and places the problem in the full context of the patient.

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    The document outlines important factors to consider when taking a patient's history for eye symptoms and disease. It discusses obtaining details on the presenting complaint, symptom characteristics, associated symptoms, pain characteristics, vision changes, discharges, and considering the patient's medical, ocular, family, and social history to properly diagnose the condition. A thorough history guides the clinical exam and investigations, and places the problem in the full context of the patient.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    64 views23 pages

    Ophthalmology IV Symptoms of Eye Disease

    Uploaded by

    Charlie Cheng-Ying Hsieh
    The document outlines important factors to consider when taking a patient's history for eye symptoms and disease. It discusses obtaining details on the presenting complaint, symptom characteristics, associated symptoms, pain characteristics, vision changes, discharges, and considering the patient's medical, ocular, family, and social history to properly diagnose the condition. A thorough history guides the clinical exam and investigations, and places the problem in the full context of the patient.

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    Symptoms of Eye

    Disease
    Samantha Watkins BOptom (Hons)
    PhD Student
    Department of Ophthalmology 2015
    HISTORY
    A careful history will:
    Suggest the disease & its cause
    Direct your clinical examination
    Direct your investigations
    Place the problem in the context of the patient and
    their circumstances as a whole
    Allows a comprehensive management plan
    HISTORY
    Standard format:

    Presenting complaint
    History of presenting complaint
    Systemic enquiry
    Past ocular history
    Past medical history
    -medications & allergies
    Family history
    Social History
    HISTORY OF
    PRESENTING COMPLAINT:
    SYMPTOM CHARACTERISTICS
    Site
    Onset
    Duration
    Severity
    Relieving or exacerbating factors
    Associated symptoms
    PRESENTING COMPLAINT:
    SYMPTOM GROUPS
    Grittiness, burning, itch, sharp pain,
    Anterior watering, discharge, redness
    Eye Blurred vision, photophobia

    Loss of vision, distortion of vision


    Posterior
    Floaters, flashers, field defect
    Eye Deep achey pain, redness

    Orbit Diplopia, ptosis, ache


    PAIN
    S.O.C.R.A.T.E.S
    Grittiness, burning, foreign body sensation
    ocular surface
    Itch allergies
    Periocular Ache assoc with redness:
    & photophobia uveitis
    & haloes/blur acute glaucoma
    & chemosis/lid swelling orbital cellulitis
    Ache at temple giant cell arteritis
    Systemic enquiry
    Consider referred pain
    PHOTOPHOBIA
    = light sensitivity

    Usually due to
    Keratitis
    or uveitis (anterior chamber inflammation
    affecting pupil movement)
    Keep in mind meningitis
    RED EYE

    Unilateralvs. bilateral
    Associated symptoms
    Pain
    Vision affected
    Discharge

    Circumstances e.g trauma, coughing


    Systemic symptoms
    DISCHARGE
    Purulent Bacterial

    Mucopurulent Chlamydia

    Mucoid Allergic

    Watery Viral
    CASE EXAMPLE
    22 yo Male 3/7 history of painful red watery,
    photophobic eye

    Cold sores on my
    nose when I
    started my exams

    Ulcers as a child
    VISION LOSS
    Sudden vs. gradual
    Intermittent vs. constant
    Unilateral vs. Bilateral
    Blur vs. field defect vs. complete blackness
    Field defect: central vs. peripheral
    Distortion: wavy lines
    Associated symptoms e.g. headache, haloes,
    pain
    VISION LOSS
    Transient: returns to normal within 24hrs
    Few seconds papilloedema,GCA
    Few mins TIA
    15-60 mins migraine (+positive symptoms)
    Visual loss >24 hours
    Sudden painless retinal artery or vein occlusion,
    retinal detachment, vitreal haem
    Gradual painless cataract, refractive error, chronic
    retinal problem
    Painful angle closure glaucoma, optic neuritis,
    uveitis
    CASE EXAMPLE
    56 yo Man with 5/7 painless blurred vision right eye
    Top half of my vision is gone
    I had episodes of complete
    loss of vision twice previously

    On further questioning:
    CABG 1997
    Smokes 20/day
    FH of hyperlipidaemia
    FLASHES & FLOATERS

    Flashes originate from stimulation of the


    neurosensory retina by traction from the vitreous
    Floaters due to degeneration of the vitreous
    Sudden onset suggest a posterior vitreous
    detachment.
    Large red/brown floaters or a drop in vision
    suggests vitreous haemorrhage
    DOUBLE VISION
    Two images are seen (true diplopia vs. ghosting)
    Monocular or binocular
    Where are they relative to each other?
    Horizontal/vertical/oblique
    Constant or variable
    DOUBLE VISION
    Onset e.g after head injury, pain when moving the
    eye orbital wall fracture
    Associated symptoms e.g headache/other cranial
    nerve defects imaging
    Past history e.g of squint can decompensate
    later in life
    Systemic enquiry e.g diabetic, myasthenia gravis,
    hyperthyroidism
    PAST OCULAR HISTORY
    Spectacle wear
    myope
    hypermetropia
    presbyopia
    Contact lens wear
    Squint or amblyopia
    Surgery or trauma
    PAST MEDICAL HISTORY
    Vascular history if acute visual loss
    Rheumatological history in patients with uveitis
    Diabetes
    Neurological problems
    Previous Cancer
    Constitutional symptoms
    Polymylagia Rheumatica
    MEDICATIONS & ALLERGIES
    Give you an idea of the
    patients general state
    of health
    Remember systemic
    medications have
    ocular effects
    Ocular medications
    have systemic effects
    FAMILY HISTORY

    Glaucoma
    Squint
    Poor vision
    Macular
    Degeneration
    Keratoconus
    Retinal
    Detachment
    SOCIAL HISTORY
    Occupation
    Driving
    Independence (particularly for elderly)
    Smoking
    Alcohol
    QUESTIONS

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