History taking examination and diminution vision
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This document discusses the process of history taking and examination in ophthalmology. It covers collecting demographic data, chief complaints, history of present and past illness, family history, and performing an examination of visual acuity, external eye, and fundus. The examination section describes assessing the forehead, eyelids, conjunctiva, cornea, anterior chamber, iris, pupil, lens, vitreous, and retina. Common symptoms and clinical features of various eye conditions are also outlined.
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History taking examination and diminution vision
- 1. History Taking and Examination DR.GAYATREE MOHANTY
- 2. Demographic data Chief presenting complaints History of present illness History of past illness Family history
- 3. Demographics Name and address Age and Sex Occupation Religion
- 4. Chief Complain Defective vision Watering and/or discharge from the eyes Redness Asthenopic symptoms Photophobia Burning/itching/foreign body sensation Pain (eyeache and/or headache) Deviation of the eye Diplopia Black spots in front of eyes Coloured halos Distorted vision
- 5. Present illness: Encourage the patient to narrate his complain Mode of onset with duration Severity Progression Accompaniment of each symptom
- 6. Past Illness Ocular history: Similar history, Spectacle, Surgeries Systemic History: Diabetes mellitus, Hypertension, Cardiac diseases, Benign htpertrophy of Prostrate, and other disease or medication being taken Family History: Refractive error, congenital/early cataract, glaucoma, retinitis pigmentosa, ptosis
- 7. Examination Testing of visual acuity External ocular examination Fundus examination
- 8. Visual acuity Checked in all patients Checks the form sense of the center of the retina. It is the ability to discriminate to separate points as separate. Distant vision with Snellen’s Chart Near vision with Jaegers Chart Roman test types
- 10. Ocular Examination Examination by diffuse illumination Examination by focal illumination Special examinations: Tonometry, gonioscopy and Fundoscopy
- 11. 1. Head Position and Chin Tilt 2. Forehead brows 3. Eyelid : Position, Movement, Margins and Lashes 4. Palpebral Fissures 5. Lacrimal apparatus 6. Eye balls: Position,Visual axis , Size 7. Conjunctiva 8. Cornea: 9. Sclera 10. Iris 11. Pupil 12. Anterior Chamber: 13. Lens: 14. Vitreous: 15. Retina
- 12. Forehead for wrinkling: Overaction of frontalis in ptosis Absent in VII n palsy Eyelids; Position, movements,lid crease, lid margin and direction of lashes
- 16. Anterior Chamber and Iris Depth: Eclipse sign Content Iris color Pattern Iridodonesis Any hole Abnormal Vasculature Absence of iris Synechia
- 17. Pupil
- 18. Lens
- 21. Diminution of Vision Sudden Gradual painless loss of vision 1. Central retinal artery occlusion 2.Massive vitreous haemorrhage 3.Retinal detachment 4. Ischacmic central retinal vein occlusion Painless onset of vision 1.Central serous retinopathy 2. Optic neuritis 3.Methyl alcohol amblyopia 4.Non-ischacmic central retinal vein occlusion painful loss of vision 1.Acute congestive glaucoma 2.Acute iridocyclitis 3.Chemical injuries to the eyeball 4.Mechanical injuries to the eyeball painless defective vision 1.Progressive pterygium involving pupillary area 2.Corneal degenerations 3.Corneal dystrophies 4.Developmental cataract 5.Senile cataract 6.Optic atrophy 7.Chorioretinal degenerations 8Age-related macular degeneration 9.Diabetic retinopathy 10. Refractive errors 11.Open angle glaucoma Painful defective vision 1.Chronic iridocyclitis 2.Corneal ulceration 3,Chronic simple glaucoma
- 24. Other Visual Symptoms Transient loss of vision: Papilledema, Carotid artery disease, Migraine, Gaint cell arteritis Night blindness : Vitamin A defieciency,High myopia Diplopia: Floaters: Vitreous haemorrhage,Vitreous degeneration. Vitreous exudates, Retinal detachment Flashes(photopsia): Retinal detachment, Posterior vitreous detachment
- 25. Colored haloes: Conjunctivitis, Cataract, Congestive angle closure glaucoma Distorted Vision: Retinal detachment, macular edema Diplopia Uniocular diplopia:Early cataract, Subluxation of lens,Astgmatism,Keratoconus Binocular Diplopa: Paralytic squint, Post squint sx., Myasthenia gravis,Blowout fractures,Thyroid disease
- 26. Watering Lacrimation; Reflex tearing: Eg FB, Corneal ulcer Epiphora : Obstruction in lacrimal apparatus
- 27. Red Eye Superficial Deep
- 28. Red Eye Feature Acute Conjunctivitis Anterior Uvietis Acute Congestive Glaucoma Onset Gradual Sudden-Gradual Sudden Pain - /Discomfort + Moderate + Severe Discharge Mucopurulent Watery Watery Color haloes + - + Diminution of Vision - Mild Marked Congestion Sperficial Conjunctival Deep Ciliary Deep ciliary Tenderness - + + Pupil Normal Sluggish Fixed and Vert. Oval Media Clear Hazy(KP,Cells,Flare) Hazy(Corneal edema) Anterior Chamber Iris Deep and quiet Normal Deep with cell and flare}. Iris muddy Shallow Iris edematous Intraocular Pressure Norma N/raised/low Markedly raised