1. DR. PRANAV BHAGWAT DR. JIJITH C.R.
eye cases: how?
DR. PRANAV BHAGWAT
DR. JIJITH C.R.

2. HISTORY TAKING
Allow patient to tell story.

3. Decreased vision Ask for Onset Duration Uni / Bilateral
Distant or near vision
Whether the patient wears glasses
Diurnal variation

4. Sudden unilateral loss of vision
Acute congestive glaucoma
Acute optic neuritis
Acute iridocyclitis
Retinal detachment
Central retinal artery occlusion
Spasm of retinal artery
Vitreous haemorrhage
Injuries

5. Sudden bilateral loss of vision
Acute methanol toxicity
Hysteria

6. Reduced vision in the morning, improved in afternoon
Intermittent corneal edema

7. Gradual onset loss of vision
Cataract
Refractory errors
Retinopathy-DM, HT
Retinal degenerations and RP
Chronic iridocyclitis
Chronic simple glaucoma
Keratitis
K opacities
Chorio retinitis
Chronic optic neuritis MS
Drug toxicity

8. Pain in the eye Type Onset Duration Diurnal variation
Associated complaints e.g., nausea, vomiting, DV

9. Severe eye pain Adhimantha K abrasions and ulcers Acute iridocyclitis
Panopthalmitis
Acute glaucoma
Scleritis
Episcleritis

10. Dull Aching pain
Cases with eye strain

11. Mild eye pain
Corneal FB
Conjunctival FB
Conjunctivitis

12. Pain around the eye
Pathology of the lid and lacrimal apparatus (eg: stye)

13. Redness of the eye

15. Normal eye lid with normal corrected visual acuity
Conjunctivitis
Keratitis
Corneal ulcer
Arjuna
Episcleritis

17. Abnormal eye lid with normal corrected visual acuity
Ectropion
Entropion
Stye
Blepharitis

18. Reduced corrected visual acuity without diplopia
Iritis
ACG
K foreign body
K ulcer

19. Reduced corrected visual acuity with diplopia
Carvernos sinus thrombosis
Orbital cellulitis
Caratico carvernos fistula

20. Common causes –red eye.

21. Photophobia
Acute infective or inflammatory lesion of the anterior segment
Recently operated eyes

22. Watering of the eyes 1)Excessive lacrimation Keratitis Uveitis
Glaucoma
2) Epiphora
Mechanical obstruction to drainage- stricture, punctal stenosis & chronic dacryocistitis
Defective orbicularis action

23. Discharge Watery-Mild bacterial infection Serous -viral
Mucoid -mild conjunctivitis
Mucopurulent & purulent- acute pyogenic infection of anterior segment
Serosanguinous- opthalmia neonatrum

24. Itching Allergic disoders- phlycten Episcleritis Spring catarrh
Allergic blepharo conjunctivitis

25. Netra daaha
Pittotklishta
Pittaja abhishyanda
Pitta vidagdha drishti.

26. Foreign body sensation
Presence of FB
Distorted eye lashes- trichiasis, entropion
Conjunctival concretion, calcification
Contact lenses

27. Black spots in front of eyes
1) Stationary
K scars, lens opacity
2) Mobile- Vitreous opacities

28. Headache Refractive errors Improperly corrected refractive errors
Zoster

29. Haloes around light 1) Early ACG 2) Acute mucopurulent conjunctivitis
3) Early stages of cataract

30. Photopsiae
Irritative lesions of retina
Impending RD

31. Diplopia
1) Unioccular- high K astigmatism, subluxated or dislocated lens
2) Binocular- Squint

32. Nyctalopia Vitamin A deficiency Retinitis pigmentosa
Pathological myopia
Glaucoma

33. Occupation Welders Black smiths- foreign body in the eye
Farmers- fungal keratitis

34. Medication 1) Gentamicin, miotics, Atropin- follicular response
2) Topical anasthetics for long time- severe corneal reactions
3) Topical and systemic steroids- K disease, cataract, glaucoma
4) Thiomersal- allergic conjunctivitis, epithelial Keratitis
5) Benzalkonium- toxic papillary reaction

35. Past history Systemic diseases- diabetis mellitus Arjuna-HT
Iritis- ankylosing spondylitis

36. History of previous ocular disease
Childhood squint- lazy eye
Blunt injury- traumatic mydriasis ( could be confused with partial third nerve palsy)

37. Family history
Chronic glaucoma- the incidence nearly 5 times greater in siblings and children of affected patients

38. Examination of the function of eye

39. Visual acuity Snellen’s chart- 6 mtrs Wear his distant corretion
One eye at a time
6/60 - 6/6
CF at 1 meter
Hand movements
PLPR

40. Jaeger’s test type
N5 to N48

41. Visual field 1) Peripheral field- confrontation or perimeter
2) Central field by scotometery

42. Colour vision
Ishiahara chart

43. Ocular and periocular examination
1) Head posture-
Paralytic squint.

44. Face
Look for
Asymmetry
Signs of paralysis
Obvious skin changes

45. Orbit
Inspection and palpation

46. Eye brows Look for loss of hair- lepromatous leprosy, myxoedema
Depigmentation

47. Eye lid
1) Position of the lid margin in relation to cornea- drooping of lids
2) Thickness of the lid
3) Swelling
Localised eg) Stye, chalazion
Generalised- Oedema,ecchymosis

48. Pakshma mandal Trichiasis- misdirection of lashes
Distichiasis- double row
Madarosis- scantiness
Matting- conjunctivitis

49. Shuklamandal (conjunctiva & sclera)
1) Bulbar conjunctiva
a) congestion- ciliary/conjunctival

50. b) Chemosis-
c) Subconjunctival haemorrhage
d) Pigmentation
e) Nodule

51. Upper tarsal conjunctiva
Congestion
Alteration of normal vertical vascular pattern
Follicle/papilla

52. Scarring
Membrane formation
Granuloma
Foreign body

53. Lower tarsal conjunctiva
As above + any sign of symblepheron

54. Staining 2% fluorescein- raw area- green
1% rose bengal- conjunctiva- pinkish red

55. Sclera Colour change Pigmentation Protrusion of uveal tissue
Congestion
Nodule formation

56. Krishnamndal (cornea & iris)
1) Size- normal (12 to 13 mm)
2) Curvature-conical / globular / flat

57. Surface- examine by window reflex / placido disc / slit lamp

58. Irregular surface- corneal ulcer, scarring
Depression / corneal facets
Elevation- epithelial bulla

59. Opacity
1) density- nebula / macula / leucoma
2) Situation and extent in relation to pupil
3) Iris adhesion

60. Pannus (sirashuklam)-
Keratic precipitates

61. Corneal sensations
Diminished sensation-
Herpes
5th nerve paralysis
ACG and absolute glaucoma
Leprosy
Prolonged use of contact lens
Post surgery
Local anaesthesia

62. Corneal stains

63. Iris 1) Iris pattern 2) Colour 3) Vessels- visible = patho.
4) Atropic patches = end stage of glaucoma

64. Defect in the iris
Iridodonesis- aphakia / buphthalmos
Iridodyalisis
Anterior synechia

65. Anterior chamber
Depth and content

66. Pupil Size- (3 to 4mm) Shape Position Pupillary margin
Pupillary aperture
Pupil reaction

67. Lens
Colour
Opacity
Position

68. Pakshmavarthmagathasanthi
Entropion
Ectropion
Tylosis
Milphosis

69. Kaneenika sandhi Lacrimal puncta- eversion / stenosis / absence
Skin around it

70. Shuklakrishnagatha santhi
Nodule
Congestion

71. Tonometry tonopen Shiotz tonometer.

72. Fundoscopy

73. Ocular coherence tomography

74. Thank you!