ophthalmology course

1. Dr/ Reyad Abo Yossif (MRCOphth)
Ophthalmology specialist
Shebin Elkom ophthalmology hospital

2. ..
How to build a workup

3. What is the meaning of stepwise approach?
1. arranged in the manner of or
resembling steps
2. with the form or appearance of steps; step by
step
Collins English Dictionary. Copyright © HarperCollins Publishers

4. Why stepwise approach?

5. It is just like
a puzzle

7. 1 . Routine history
- Personal history
- Complaint
- History of Present illness
- Past history
- Family history
- Peri-natal
- Old photos

8. 2 . Define the problem
( main symptom / main sign / main DD)
,e.g. Acute red eye , Sudden/ recent loss of vision ,
Gradual loss of vision ,The watery eye , Flashes and
floaters , Headache , Diplopia , Anisocoria ,
Nystagmus
,e.g. Diminution of vision directs mind to ( EMSAH )
error of refraction ,media opacity , sensory defect ,
amblyopia , malingering

9. All roads lead to Rome

10. 3 . Set a DD
- Exclude most dangerous
- Common is common
- Most related
- Most treatable
- Systematic ( VITAMIN CDEF)
- List DD in an ordered manner according to
common criteria ,e.g. laterality , age , onset

11. Examples
#Acute vs chronic diminution of vision
#Uveitis in paediatric vs old age
#Unilateral vs bilateral proptosis

12. VITAMIN CDEF
 V –Vascular
 I-Infection/Inflammatory
 T-Traumatic
 A-Autoimmune
 M-Metabolic
 I-Iatrogenic
 N-Neoplastic
 C-Congenital
 D-Degenerative
 E-Endocrine
 F-Functional

16. Exclude
- Exclude pseudo ( ptosis , proptosis , squint ,
papilloedema , macular hole)
- Exclude secondary (uveitis , glaucoma , cataract ,
CSR )

18. History Taking

19. # Personal history
ASR : Age , Sex , Race
SAD : Smoking , Alcohol , Diet
POR :Pets , Occupation , Residence

20. # Main Complaint
- Patient own words
- Catch the main symptom or sign

21. # History of Present illness :

22. # History of Present illness :
1.Onset , course , duration
2.what increases , what decreases , associated
symptoms
3. other symptoms related to DD
4. PDR : pain , drop of vision , redness

23. # Past history :
1.Trauma : timing , nature (surgical or not) ,
treatment , complications
2. Tumour :nature , prognosis , treatment
3.Treatment (eye) : optical , medical , laser ,
surgical
4. Treatment (systemic): DM , HTN , Ashmatic
, HCV , Thyroid , Rheumatic , Cardiac , Renal ,
Neurological , Anti-coagulants ,Pregnancy ,
Lactation

24. Detailed questions about :
Trauma
Surgeries
Headache
Contact lenses
Diabetes Milletus
Thyroid disease

25. # Family history :
-positive or negative
,e.g. glaucoma , retinitis
pigmentosa

26. # Perinatal :
- Ante-natal : drugs / rash / fever during
pregnancy
- Natal : preterm / complicated delivery
- Post-natal : incubator / oxygen supply

27. # Old photos :
-if ptosis / proptosis / posture abnormality