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COMMON SIGNS AND SYMPTOMS OF EYE DISEASES. Components of the Ocular History Chief complaint –What are the main problems that you are having with your.

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Presentation on theme: "COMMON SIGNS AND SYMPTOMS OF EYE DISEASES. Components of the Ocular History Chief complaint –What are the main problems that you are having with your."— Presentation transcript:



3 Components of the Ocular History Chief complaint –What are the main problems that you are having with your eyes? –What other problems are you having with your eyes? –Why did you come (or why were you sent) here? –In what way are you hoping that you might be help? –What is it about your eyes that worries or concerns you? –What is the main problem that you would like me to address?

4 1. Visual Loss- –A. transient visual loss- migraine, ischemia to eye /visual cortex –B. acute, persistent visual loss –C. chronic, progressive, visual loss- refractive, problems with ocular media or visual pathway 2. Diplopia -monocular vs. binocular

5 3. Anisocoria 4. Metamorphopsia 5. Flashes of light -migraine, occipital epilepsy, retinal visual pathway lesion 6. Floaters- vitreous & retina 7. Eye pain- ocular & trigeminal nerve stimulation 8. Proptosis 9. Ptosis 10. Tearing -inflammation of the cornea, conjunctiva, eyelids, lids, lacrimal drainage, dry eye syndrome

6 Decreased blurred central vision (distance, near or both) Decreased peripheral vision Altered image size (micropsia, macropsia, metamorphopsia) Diplopia (monocular, binocular, horizontal, vertical or oblique) Photopsias (flashes of light) Common Complaints

7 Iridescent vision (halos, rainbows) Dark adaptation problems Dyslexia (medical inability to read with normal understanding) Color vision abnormalities Blindness Oscillopsia (apparent movement or shaking of images)

8 History of Present Illness Onset (sudden or gradual); severity (improved, worsened or remained the same); Influences/Precipitating Condition; Constancy and Temporal Variation; Laterality: unilateral or bilateral –list ocular medications as well

9 Ocular Medications Medication should be recorded including dosages, frequency and duration of use, over-the-counter drugs and home remedies Color coded of the cap of container Green: cholinergic or miotic drugs (pilocarpine, carbachol) Red: anticholinergic or dilating cycloplegic (atropine, tropicamide, cyclopentolate, phenylephrine) Yellow: Beta-adrenergic blocking agent (timoptol) White: antibiotics, artificial tears, corticosteroids Orange: (dorzolamide)

10 general state of health –principal systemic illnesses –Vascular disorders commonly associated with ocular manifestations-such as diabetes and hypertension-should be asked –list the patient's systemic medications –any drug allergies should be recorded Use of eyeglasses or contact lens Use of ocular medications in the past Ocular surgery Ocular trauma Past medical history

11 Systemic Medications Use of aspirin, anticoagulant agent, antibiotics, tranquilizers, narcotics, anti- inflammatory agents, anticonvulsants, contraceptives, or vitamins

12 Allergies Medications Environmental agents resulting in: Atopic dermatitis Allergic asthma Allergic rhinitis, conjunctivitis (hay fever) Urticaria (hives) Vernal conjunctivitis

13 Family history –strabismus, amblyopia, glaucoma, cataracts, and retinal problems, such as retinal detachment or macular degeneration. –Medical diseases such as diabetes may be relevant as well

14 COMMON OCULAR SYMPTOMS three basic categories: I. abnormalities of vision II. abnormalities of ocular appearance III. and abnormalities of ocular sensation- pain and discomfort.

15 I. ABNORMALITIES OF VISION 1. Visual Loss –due to abnormalities anywhere along the optical and neurologic visual pathway. –consider refractive (focusing) error, lid ptosis, clouding or interference from the ocular media (eg, corneal edema, cataract, or hemorrhage in the vitreous or aqueous space), and malfunction of the retina (macula), optic nerve, or intracranial visual pathway.

16 2. Visual Aberrations Glare or haloes –-may result from uncorrected refractive error, scratches on spectacle lenses, excessive pupillary dilation, and hazy ocular media, such as corneal edema or cataract. Visual distortion –(apart from blurring) may be manifested as an irregular pattern of dimness, wavy or jagged lines, and image magnification or minification. Flashing or flickering –lights may indicate retinal traction (if instantaneous) or migrainous scintillations that last for several seconds or minutes.

17 Floating spots –may represent normal vitreous strands due to vitreous "syneresis" or separation or the pathologic presence of pigment, blood, or inflammatory cells. Double vision (monocular or binocular) –(ie, disappears if one eye is covered). Monocular diplopia –Persists when one eye is covered –It is caused by an optical aberration (cataract, uncorrected refractive error, presbyopia, keratopathy). Binocular diplopia –disappears when either eye is covered. –It results from misalignment of the eyes, and may be caused by: –a central nervous system lesion –an ocular motor nerve lesion –a neuromuscular junction lesion –extraocular muscle lesion

18 SYMPTOMS Early –Difficulty reading, driving, etc –Straight lines may be crooked Advanced: central blind spot Peripheral vision remains –Independent living skills Disturbance of vision first Progressing to diminution Cataract size & location determine impairment

19 Ptosis (drooping of the eyelid) Proptosis (protrusion of the eyes) Enophthalmos (opposite of proptosis) Blepharitis Misalignment of the eyes Redness, other discolorations, opacities and masses Anisocoria (inequality of the pupils) II. Abnormal appearances

20 Foreign body sensation Ciliary deep pain Photophobia (pain that is present upon exposure to light) Headache Burning Dryness Itching Asthenopia (eyestrain) III. Ocular pain or discomfort

21 Lacrimation Epiphora (actual spilling of tears) Dryness Discharge Abnormal ocular secretions

22 VISUAL ACUITY numerator - testing distance from the eye to the chart being used (20 feet or 6 meters); denominator - distance to which the subject with an impaired vision can read the same figure.

23 Testing Distance Visual Acuity 1. Ask the patient to stand or to sit at a designated testing distance, 20 feet from a well- illuminated wall chart. 2.Occlude the left eye. 3.Ask the patient to read aloud each letter, number or picture from left to right. 4.Note the corresponding acuity measurement shown at that line of the chart. Record the VA of each eye separately with correction and without correction. 5.Repeat steps 1-4 for the left eye, with the right eye covered. 20 ft

24 The pinhole admits only central rays of light which do not require refraction by the cornea or lens. A single pinhole no more than 2.4 mm in diameter should be used. Pinhole acuity test

25 Testing Pinhole Visual Acuity 1.Position the patient and occlude the eye not being tested, as done for the distance acuity test. 2.Ask the patient to hold the pinhole occluder in front of the eye that is to be tested. 3.Instruct the patient to look at the distance chart through the single pinhole or through any one of the multiple pinholes. 4.Instruct the patient to use small hand or eye movements to align the pinhole to resolve the sharpest image on the chart. 5.Ask the patient to begin to read the line with the smallest letters that are legible as determined on the previous vision test without the use of the pinhole. 6.Record the Snellen acuity obtained and precede or follow it with the abbreviation PH.


27 Used to express near visual acuity. The test is usually performed at 16 in or 40 cm. Jaeger chart

28 Testing Near Visual Acuity 1.Instruct the patient to hold the test card at the distance specified on the card (16 in or 40 cm). 2.Ask the patient to occlude the left eye. 3.Ask the patient to read each word on the line of smallest character that is legible in the card. 4.Record the VA for each eye separately. 5.Repeat the procedure with the right eye occluded.

29 Testing Poor Vision Count fingers (CF) Hand moving (HM) Light perception (LP) If cannot perceive light: totally blind (NLP or no light perception)

30 Testing Peripheral Vision Confrontation test Simultaneous confrontation test

31 Test for Pupils Direct response to light Consensual constriction Swinging penlight test for Marcus Gunn Pupil or relative afferant pupillary defect

32 The “swinging flashlight test” assesses CN II, CN III (parasympathetic innervation of the sphincter pupillae muscle), and sympathetic innervation of the dilator pupillae muscle.

33 Test for Ocular motility

34 Testing Alignment Cover test: gaze at a distant object. Cover one eye

35 Direct Ophthalmoscopy Fundus examination Anterior segment examination Red reflex examination


37 Mydriatic (dilating) Drops 2.5% phenylephrine 0.5%-1% tropicamide

38 Specialized Ophthalmologic Examinations Perimetry systematic measurement of visual field function (the total area where objects can be seen in the peripheral vision while the eye is focused on a central point

39 Specialized Ophthalmologic Examinations Amsler Grid tool for monitoring central visual field. to detect early and sometimes subtle visual changes in a variety of macular diseases such as age-related macular degeneration and diabetic macular edema

40 Metamorphopsia: macular edema, submacular fluid

41 Color Vision Testing

42 Thank you

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