ophthalmology course

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

2. Workup .4
Examination

3. Workup Journey Steps

4. 1 . Routine history
- Personal history
- Complaint
- History of Present illness
- Past history
- Family history
- Peri-natal
- Old photos

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

6. # Main Complaint
- Patient own words
- Catch the main symptom or sign to set a DD

7. # 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
(dangerous criteria , don’t forget)

8. # 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

9. # Family history :
-positive or negative
-ask about Consanguinity

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

11. # Old photos :
-if ptosis / proptosis / posture abnormality/
cosmetic problem

12. 2 . Define the problem
( main symptom / main sign / main DD)

13. 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

14. 4 - Routine examination
a) Observe
b) UAVA / BCVA
c) Slit-lamp
d) Pupil
e) IOP
F ) Fundus

15. Observe
General + 4P
 General observation of the patient
 1. Primary position
 2. Ptosis
 3. Proptosis
 4. Prescription (glasses)

16. UAVA & BCVA
 Far vision
 Near vision
 Don't ignore the value of pinhole test
 Don’t forget glasses prescription verification
skills,e.g., Duochrome test

17. Slit-lamp
- Begin with a lower magnification
- Follow an exam algorithm, beginning with external
features and working towards deeper structures
- Use the different exam techniques
- Don’t forget the accessory examination tests ,e.g. tear
film breakup time, siedel test , van herick test ,
fluorescein dye disappearance test …….etc.

18. Pupil
- Observe ( Check lids for ptosis, iris colour for heterochromia)
- Ask patient to look at a distant target (to avoid near reflex)
- Measure pupil diameters in ambient bright light
- Measure pupil diameters in ambient dim light ( discover Anisocoria)
- Check direct and consensual pupillary response for each side
- Check for RAPD
- Ask patient to look at a near target ( Check near response )

19. IOP
The standard way is applanation tonometry
It is just a part of the disease , not the diagnosis

20. Fundus
- Disc
- Peripapillary area
- Papillomacular bundle
- Macula
- Vessels
- Background
- Periphery

21. 6 -Special investigations :
(ask yourself about its value)
•Laboratory ,e.g. thyroid profile ,
lipid profile , CBC
•Imaging ,e.g. FFA, OCT ,CT, MRI
•Invasive ,e.g. biopsy
•Specific ,e.g. RF , C-ANCA

22. 7- Did you reach diagnosis?
It is not the end , check for missed
parts

23. 7- Did you reach diagnosis?
It is not the end !!!
 -Is it a confirmed diagnosis?
 -Is it an emergency or not?
 -Did you catch the cause , risk factors or
predisposing factors?
 - What about complications?
 -What about medico-legal aspects?

24. 7 - Treatment :
-Counselling
-Emergency
-Prophylactic
-Definitive
-Complications ttt

25. Pearls in treatment :
 Tailor ttt according to your patient
 It is a ( PLAN), not just a presciption
 Counselling , Counselling , Counselling
 Is it evidence-based ttt ?
 Is there any precaution to drugs?

26. 8 . Outline risk factors
affecting morbidity , mortality , laterality
,or affecting ttt
-,e.g. Necrotising scleritis (fatal) ,
GCA (steroids prevent blindness) ,
ARN (acyclovir protects other eye) ,
glaucoma drugs contraindications (no
epinephrine in arrhythmic patient)

27. 9- Follow-up : for
-Compliance to ttt
-Complications
-Progression
-Recovery
-Other eye involvement
-Systemic features