introduction to ophthalmolgy ophthalmology sheet (history & examination) common eye diseases medical student 4th year KFS university.

1. History Taking&
Examination of
Eye
BY/
MOHAMED AHMED EL –SHAFIE
ASSISTANT LECTURER IN OPHTHALMOLOGY DEPARTMENT
KAFRELSHIEKH UNIVERSITY

2. Objective of the Tutorial
► To give a simple introduction to
clinical anatomy, physiology &
embryology of the eye.
► TO recognize clinical approach to the eye
Complaints.

3. Anatomy of the eye

4. Eyelids

5. Tears

6. visual pathway

7. History
‫العيان‬ ‫اسمع‬

8.  A good history commonly leads to a diagnosis
 Helps you focus your examination
 Indicates when/what investigations are needed

9. Introduce yourself.
• Note – never forget patient names
•Respect patient privacy.
General Approach
Try to see things from patient point of view. Understand
patient mental status, anxiety, irritation or depression.
Listening
Questioning: simple/clear/avoid medical terms/leading,
interrupting, direct questions and summarizing.

10. STRUCTURAL ORGANISATION OF
HISTORY
1. PERSONAL DATA
2. PRESENTING COMPLAINTS (P/C)
3. PAST OCULAR HISTORY (POHx)
4. PAST MEDICAL HISTORY (PMHx)
5. DRUG HISTORY (DHx)
6. FAMILY HISTORY (FHx)
7. SOCIAL HISTORY (SHx)

11. PERSONAL HISTORY
 Name: To be familiar with your patient
 Age:
Buphthalmos in infants
Keratoconus in teenage
Senile cataract in old age
 Sex:
Males as Retinitis pigmentosa
Females as Autoimmune Diseases
 Address: to know socioeconomic state
 Telephone no: to keep contact with your patients
 Special habits: Sports and smoking
 Occupations: metal workers

12. COMPLAINTS
Patient Own Words
‫بالعربى‬ ‫لو‬ ‫حتى‬

13. Chief Complaint
• The main reason push the pt. to seek for visiting a ophthalmic
consultation.
• Usually a single symptoms, occasionally more than one complaints
e.g. blurred vision, swelling, pain, trauma, inflammation etc.
• The patient describe the problem in their own words.
• It should be recorded in his/her own words.
• What brings your here? How can I help you? What seems to be the
problem?

14.  How long?
 Involving one or both eyes?
 Any associated symptoms?
 Any similar problems before?
Analysis of complaints

15. COMPLAINTS
*Diplopia: uniocular or binocular
*Flashes of lights: RD
*Floaters as Musca volitans
*Metamorphopsia as in macular diseases
*Field defects: glaucoma
 Visual :
*Diminution of vision:
 Gradual: Cataract or errors of refraction
 Sudden: CRAO

16. COMPLAINTS
 Non Visual:
 Eyelid Oedema
 Redness
 Lacrimation
 Discharge
 Itching
 Burning
 FB sensation
 Pain
 Phtophopia

17. PAST OCULAR HISTORY (POHx)
 Any ocular medications, surgery, eye hospital
visits
 Use of spectacles, contact lenses etc.
 Last time spectacles where changed.

18. PAST MEDICAL HISTORY (PMHx)
DM
HTN
HIV
RHEUMATOID ATHRITIS
ASTHMA
CARDIAC DISEASE

19. DRUG HISTORY (DHx)
BETA BLOCKERS
ANTI COAGULANTS
STEROIDS – in steroid responders, causes
glaucoma
TOPICAL GENTAMYCIN – causes epithelial
toxicity

20. FAMILY HISTORY (FHx)
 Myopia,
 Squint,
 Glaucoma
 Eye cancer
 Retinitis Pigmentosa

21. SOCIAL HISTORY
 Smoking
 Alcohol
 Occupation
 Home circumstances

22. EXAMINATION
 OD (oculus dexter) right eye.
 OS (oculus sinister) left eye.
 OU (oculus uterque) both eyes
 RE
 LE
 BE

23. EXAMINATION
Visual Acuity
(VA)

24. NORMAL VISUAL RESPONSE
Age Visual response
Newborn Light perception
4-7 weeks Eye contact with mother
4-12 weeks Fixates and follows interesting bright
coloured objects
3 months Change expression smiles and cries
3-4 months Reach objects using vision
6-9 months Crawling and later walking avoiding
objects
Gwiazda et al 1980

25. FIXATION TARGETS (fix and follow) :
 If appropriate targets are used, this reflex can be demonstrated
by about 6 wk of age.
Binocular fixation preference :

26. OPTICOKINETIC NYSTAGMUS :
 Evaluation of the presence or absence of
opticokinetic nystagmus was the first “technologic”
approach to acuity measurement in preverbal
children.

27. VISUAL ACUITY
Rules
 It is a test for central vision only
 Discuss gratings with your patient
 Start with one eye (uniocular)
 Good illuminated chart with higher contrast

29. REFRACTIVE ERRORS

30. VISUAL ACUITY
Pin Hole test
To differentiate refractive errors
from organic diseases by
blocking peripheral rayes

31. VEDIO

32. VISUAL ACUITY
Interpretation
UCVA
BCVA
6/6
20/20
1.00

33. EXAMINATION
1. ADNEXA
2. ANTERIOR SEGMENT
3. POSTERIORS SEGMENT

34. SLIT LAMP
BIOMICROSCOPE

35. ADNEXA
 ORBITAL RIM
 EYE BROW
 EYE LASHES
 ORIFICES
EYE LIDS:Ptosis
Lid retraction

36. ANTERIOR SEGMENT
 CONJUNCTIVA
 CORNEA
 A/C
 PUPIL
 IRIS
 LENS

37. Examination of IRIS
 COLOUR
 Light blue or green in Caucasians and Dark brown in
orientals
 Heterochromia iridium- different colour
of 2 iris
 Heterochromia iridis-different colour of sectors of the
same iris

38. Examination of PUPIL
 NUMBER
o Normal: 1 pupil
o Rarely: more than 1 pupil (polycoria)
 LOCATION
o Normal: almost centre of the iris, slightly nasal
o Rarely: congenitally eccentric (corectopia)
 SIZE
o Normal: 3-4mm depending upon illumination
o It may be abnormally small (miosis) or large(mydriasis)
o Anisocoria- It is a condition where there is difference
between the size of two pupils

39. Examination of LENS
 POSITION
o Normal: patellar fossa by the zonules
o Dislocation of lens: lens not present in its normal position
i. Anterior dislocation-present in anterior chamber
ii. Posterior dislocation-present in vitreous cavity

40. o Subluxation of lens-lens is partially displaced from its position
• Causes-trauma, marfan’s syndrome, homocystinuria
o Aphakia-absence of lens
• It is diagnosed by
i. jet black pupil, deep anterior chamber, empty patellar fossa by slit
lamp biomicroscopy
ii. hypermetropic eye on ophthalmoscopy, retinoscopy
iii. ABSENCE of 3rd and 4th purkinje images
o Pseudophakia-
• When posterior chamber IOL is present, it is diagnosed by black
pupil, deep anterior chamber, shining reflexes (from anterior surface of
IOL) and PRESENCE of all the four Purkinje images

41. POSTERIOR SEGMENT
 VITREOUS: Haziness, cells, h’age
 OPTIC NERVE: CDR, pale, blurred
margin
 VESSELS: aneurysm, Ghost vessels
 MACUALR: normal, dull reflex, h’age.
hole

42. Techniques of Fundus Examination
1) Ophthalmoscopy
a) Distant direct ophthalmoscopy
b) Direct ophthalmoscopy
c) Indirect ophthalmoscopy
2) Slit lamp bio-microscopic examination by
a) Indirect slit lamp bio-microscopy
b) Hruby lens bio-microscopy
c) Contact lens bio-microscopy

45. THANK YOU