Ophthalmology History Taking PDF

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Summary

History taking in Ophthalmology ...

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History Taking:  Presenting Complaint  History of Presenting Complaint  Past Ocular History  Past Medical History  Family History  Social History  Drugs and Allergies Red Eye: - Unilateral o Infection o Uveitis o Acute Glaucoma - Bilateral o Allergy - Itching? Gritty? Deep pain? Photophobia? - Watery? Purulent? Mucoid? - Transient blurring from watering and discharge - Persistent visual loss = More serious disease - Recurrent disease? - Refraction: Hypermetropic? Contact lens use? - URTI? Atrophy? - Systemic Associations: spondyloarthropathy, RA, blepharitis Gradual Loss of Vision - Near Vision: Macula/Posterior Subscapular Cataract - Risk factors for cataracts: trauma, myopia, uveitis, topical steroids - DM, Chloroquine, Tamoxifen  Retinopathy - Steroids  cataract/glaucoma - FH: Glaucoma, hereditary disease, early onset cataract Sudden Loss of Vision - Central? Peripheral? Hemianopia? - Acute onset? Recurrent? - Profound? Blurring? Distortion? - Painful and red - Headache, nausea - Pain on eye movements - Vasculitis, Neurological Conditions Double Vision - Horizontal or Vertical - Binocular - Intermittent or Constant - Trauma: intracranial, orbital floor

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Vascular, TED, IIH, MG Ophthalmoplegia: paralysis of eye muscles

Childhood Strabismus - Age/duration - Previous screening - Timing - Exacerbating factors - Leukocoria - Refractive error - Previous treatment for squint - Congenital cataract - Pre/peri/post-natal factors - Current general health - FH: strabismus, amblyopia, refractive error Flashes and Floaters - Sudden: PVD or possible retinal detachment - Transient with movement: PVD - Intermittent and in a pattern: Migraine - Myopia: PVD - PMH: DM, Vitreous Haemorrhage, Migraine, Uveitis Proptosis - Reduction in vision - Thyroid dysfunction most common - Large eye? Myopia - SOL or Orbital Cellulitis - Enophthalmos of fellow eye Irritable Eye - Dry Eyes: worse in warm weather, at end of day, in elderly - Blepharitis: sticky, crusting, worse in mornings - Corneal Problems? - Contact Lenses - Allergy to topical medication - RA: keratoconjuctivitis sicca - Thyroid Dysfunction: exposure keratopathy - Dermatological disorders: atopy/acne rosacea Trauma - Sharp/blunt/chemical/ - IOFB - Force - Poor correlation - Hyphaema: blood within the anterior chamber ? TON? Retro-orbital haemorrhage? - Diplopia/Infraorbital anaesthesia

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Consider coexisting systemic injuries Orbital Floor is very weak, if missed can cause later problems involving fibrotic vessels. CT Orbit is diagnostic of orbital floor fracture...