1. Case history

2. Case history
◉ Is the cornerstone of an optometric
examination.
◉ Role and significance:
◉ To determine which specific tests or
procedures should be performed during the
examination and, after interpretation and
analysis, ultimately will lead to a definitive
diagnosis and management plan.

3. ◉ Essentials questions:
I. Does the patient have a problem ?.
II. What is the specific problem ?
III. What is or will be the effect of the
problem on the patient performance?
Cont :

4. ◉ Case history elements:
◉ Chief complaint:
What is the problem?
What is the reason for this visit?
What brings you to day?
Cont :-

5. ◉ Medical history:
◉ Are you in good general health?
◉ Do you have any health problem?
◉ Do you have any health problems such as
high blood pressure or diabetes?
Cont :-

6. ◉ Visual and ocular history:
◉ When was you last eye examination?
◉ How long have you wearing glasses?
◉ Have you ever had an eye diseases ,injuries , or surgery?
Cont :-

7. ◉ Family ocular history:
◉ Has any one in your family had an eye disease such
as cataract, or glaucoma?
◉ Family medical history:
◉ Does any one in your family have any systemic
health problems such as high blood pressure or
diabetes?
Cont :-

10. Lids and lashes
 Use diffuse illumination with the illumination arm
set approximately 30 from the straight ahead
position.
 Set the magnification on a low setting (6x or
10x).
 Instruct the patient to close his eyes. Starting at
the temporal canthus , scan across the upper lid
and lashes
 Instruct the patient to open his eyes . Scan from
nasal to temporal across the lower lid and
lashes

12. dit

14. conjunctiva
 Narrow beam to a wide parallelepiped, with the
illumination arm set approximately 30 degree
from the straight ahead position
 Keep the magnification on a low setting
 Instruct the patient to open his eyes and look
up.
 Inform the patient that you are going to touch
his lower lid. Place your index finger close to
the patient lower lash margin and evert the
lower lid . Scan the inferior palpebral and bulbar
conjunctiva

15. conjunctiva
 You should be scanning from temporal to nasal.
 Instruct the patient to look down.
 Inform the patient that you are going to touch
his upper lid .place your thumb close to upper
lash margin and elevate the lid .scan across the
superior bulbar conjunctiva .
 Instruct the patient to look first to the left and
then to the right ,while you scan the nasal and
temporal bulbar conjunctiva.
 If indicated ,evert the upper lid at this time

20. Iris
 Increase the slit width to a wide
parallelepiped 3mm.
 Keep the magnification at medium setting.
 Instruct the patient to look straight ahead.
 Scan across the iris surface looking for
irregularities
 Note the pupillary light reflex.

21. Crystalline lens
 Narrow the angle of illumination arm to about
10-20 degree.
 Magnification at medium setting.
 Reduce the slit beam to a narrow parallelepiped
 Slowly move the slit lamp closer to the patient
until the light is direct through the pupil and
becomes sharply focus on the anterior surface
of the lens
 Then move the biomicroscope closer to the
patient to examine the deeper layers of the lens.

23. THANK YOU