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    History Taking& Examination of Eye: Mohamed Ahmed El - Shafie

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    sandeep
    This document provides guidance on performing a thorough history and examination of the eye. It begins by outlining the importance of history taking in guiding the examination and aiding diagnosis. It then details the structured approach to collecting a patient's personal data, complaints, ocular history, medical history, medications, family history, and social factors. Finally, it describes the key components of a complete eye examination, including visual acuity, adnexa, anterior segment, and posterior segment evaluation. The goal is to gather all relevant information to understand the patient and their ocular health through both interview and clinical inspection.

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    History Taking& Examination of Eye: Mohamed Ahmed El - Shafie

    Uploaded by

    sandeep
    261 views38 pages
    This document provides guidance on performing a thorough history and examination of the eye. It begins by outlining the importance of history taking in guiding the examination and aiding diagnosis. It then details the structured approach to collecting a patient's personal data, complaints, ocular history, medical history, medications, family history, and social factors. Finally, it describes the key components of a complete eye examination, including visual acuity, adnexa, anterior segment, and posterior segment evaluation. The goal is to gather all relevant information to understand the patient and their ocular health through both interview and clinical inspection.

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    ophthalmolgysheet-170924155936.pdf

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    This document provides guidance on performing a thorough history and examination of the eye. It begins by outlining the importance of history taking in guiding the examination and aiding diagnosis. It then details the structured approach to collecting a patient's personal data, complaints, ocular history, medical history, medications, family history, and social factors. Finally, it describes the key components of a complete eye examination, including visual acuity, adnexa, anterior segment, and posterior segment evaluation. The goal is to gather all relevant information to understand the patient and their ocular health through both interview and clinical inspection.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    261 views38 pages

    History Taking& Examination of Eye: Mohamed Ahmed El - Shafie

    Uploaded by

    sandeep
    This document provides guidance on performing a thorough history and examination of the eye. It begins by outlining the importance of history taking in guiding the examination and aiding diagnosis. It then details the structured approach to collecting a patient's personal data, complaints, ocular history, medical history, medications, family history, and social factors. Finally, it describes the key components of a complete eye examination, including visual acuity, adnexa, anterior segment, and posterior segment evaluation. The goal is to gather all relevant information to understand the patient and their ocular health through both interview and clinical inspection.

    Copyright:

    © All Rights Reserved
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    of 38

    History Taking&

    Examination of
    Eye
    BY/
    MOHAMED AHMED EL –SHAFIE

    ASSISTANT LECTURER IN OPHTHALMOLOGY DEPARTMENT


    KAFRELSHIEKH UNIVERSITY
    ‫‪History‬‬
    ‫اسمع العيان‬
     A good history commonly leads to a diagnosis

     Helps you focus your examination

     Indicates when/what investigations are needed


    General Approach
    Introduce yourself.
    • Note – never forget patient names
    •Respect patient privacy.

    Try to see things from patient point of view. Understand


    patient mental status, anxiety, irritation or depression.

    Listening

    Questioning: simple/clear/avoid medical terms/leading,


    interrupting, direct questions and summarizing.
    STRUCTURAL ORGANISATION OF
    HISTORY

    1. PERSONAL DATA
    2. PRESENTING COMPLAINTS (P/C)
    3. PAST OCULAR HISTORY (POHx)
    4. PAST MEDICAL HISTORY (PMHx)
    5. DRUG HISTORY (DHx)
    6. FAMILY HISTORY (FHx)
    7. SOCIAL HISTORY (SHx)
    PERSONAL HISTORY
     Name: To be familiar with your patient
     Age:
    Buphthalmos in infants
    Keratoconus in teenage
    Senile cataract in old age
     Sex:
    Males as Retinitis pigmentosa
    Females as Autoimmune Diseases

     Address: to know socioeconomic state


     Telephone no: to keep contact with your patients
     Special habits: Sports and smoking
     Occupations: metal workers
    COMPLAINTS

    Patient Own Words

    ‫حتى لو بالعربى‬
    Chief Complaint
    • The main reason push the pt. to seek for visiting a ophthalmic
    consultation.

    • Usually a single symptoms, occasionally more than one complaints


    e.g. blurred vision, swelling, pain, trauma, inflammation etc.

    • The patient describe the problem in their own words.

    • It should be recorded in his/her own words.

    • What brings your here? How can I help you? What seems to be the
    problem?
    Analysis of complaints
     How long?
     Involving one or both eyes?

     Any associated symptoms?

     Any similar problems before?


    COMPLAINTS
     Visual :
    *Diminution of vision:
     Gradual: Cataract or errors of refraction

     Sudden: CRAO

    *Diplopia: uniocular or binocular


    *Flashes of lights: RD
    *Floaters as Musca volitans
    *Metamorphopsia as in macular diseases
    *Field defects: glaucoma
    COMPLAINTS
     Non Visual:
     Eyelid Oedema
     Redness
     Lacrimation
     Discharge
     Itching
     Burning
     FB sensation
     Pain
     Phtophopia
    PAST OCULAR HISTORY (POHx)

     Any ocular medications, surgery, eye hospital


    visits

     Use of spectacles, contact lenses etc.

     Last time spectacles where changed.


    PAST MEDICAL HISTORY (PMHx)

    DM
    HTN
    HIV
    RHEUMATOID ATHRITIS
    ASTHMA
    CARDIAC DISEASE
    DRUG HISTORY (DHx)

    BETA BLOCKERS
    ANTI COAGULANTS
    STEROIDS – in steroid responders, causes
    glaucoma
    TOPICAL GENTAMYCIN – causes epithelial
    toxicity
    FAMILY HISTORY (FHx)

     Myopia,
     Squint,
     Glaucoma
     Eye cancer
     Retinitis Pigmentosa
    SOCIAL HISTORY

     Smoking
     Alcohol
     Occupation
     Home circumstances
    EXAMINATION

     OD (oculus dexter) right eye.  RE

     OS (oculus sinister) left eye.  LE

     OU (oculus uterque) both eyes


     BE
    EXAMINATION

    Visual Acuity
    (VA)
    NORMAL VISUAL RESPONSE
    Age Visual response

    Newborn Light perception

    4-7 weeks Eye contact with mother


    4-12 weeks Fixates and follows interesting bright
    coloured objects

    3 months Change expression smiles and cries


    3-4 months Reach objects using vision
    6-9 months Crawling and later walking avoiding
    objects
    Gwiazda et al 1980
    FIXATION TARGETS (fix and follow) :
     If appropriate targets are used, this reflex can be demonstrated
    by about 6 wk of age.

    Binocular fixation preference :


    OPTICOKINETIC NYSTAGMUS :

     Evaluation of the presence or absence of


    opticokinetic nystagmus was the first “technologic”
    approach to acuity measurement in preverbal
    children.
    VISUAL ACUITY
    Rules
     It is a test for central vision only
     Discuss gratings with your patient

     Start with one eye (uniocular)

     Good illuminated chart with higher contrast


    VISUAL ACUITY
    Pin Hole test
    To differentiate refractive errors
    from organic diseases by
    blocking peripheral rayes
    VEDIO
    VISUAL ACUITY

    Interpretation
    UCVA
    BCVA
    6/6
    20/20
    1.00
    EXAMINATION

    1. ADNEXA
    2. ANTERIOR SEGMENT
    3. POSTERIORS SEGMENT
    SLIT LAMP
    BIOMICROSCOPE
    ADNEXA

     ORBITAL RIM
     EYE BROW

    EYE LIDS:Ptosis
    Lid retraction
     EYE LASHES
     ORIFICES
    ANTERIOR SEGMENT

     CONJUNCTIVA
     CORNEA
     A/C
     PUPIL
     IRIS
     LENS
    Examination of IRIS
     COLOUR

     Light blue or green in Caucasians and Dark brown in


    orientals
     Heterochromia iridium- different colour
    of 2 iris
     Heterochromia iridis-different colour of sectors of the
    same iris
    Examination of PUPIL
     NUMBER
    o Normal: 1 pupil
    o Rarely: more than 1 pupil (polycoria)
     LOCATION
    o Normal: almost centre of the iris, slightly nasal
    o Rarely: congenitally eccentric (corectopia)
     SIZE
    o Normal: 3-4mm depending upon illumination
    o It may be abnormally small (miosis) or large(mydriasis)
    o Anisocoria- It is a condition where there is difference
    between the size of two pupils
    Examination of LENS
     POSITION
    o Normal: patellar fossa by the zonules
    o Dislocation of lens: lens not present in its normal position
    i. Anterior dislocation-present in anterior chamber

    ii. Posterior dislocation-present in vitreous cavity


    o Subluxation of lens-lens is partially displaced from its position
    • Causes-trauma, marfan’s syndrome, homocystinuria
    o Aphakia-absence of lens
    • It is diagnosed by
    i. jet black pupil, deep anterior chamber, empty patellar fossa by slit
    lamp biomicroscopy
    ii. hypermetropic eye on ophthalmoscopy, retinoscopy
    iii. ABSENCE of 3rd and 4th purkinje images
    o Pseudophakia-
    • When posterior chamber IOL is present, it is diagnosed by black
    pupil, deep anterior chamber, shining reflexes (from anterior surface of
    IOL) and PRESENCE of all the four Purkinje images
    POSTERIOR SEGMENT

     VITREOUS: Haziness, cells, h’age

     OPTIC NERVE: CDR, pale, blurred


    margin

     VESSELS: aneurysm, Ghost vessels

     MACUALR: normal, dull reflex, h’age.


    hole
    Techniques of Fundus Examination
    1) Ophthalmoscopy
    a) Distant direct ophthalmoscopy
    b) Direct ophthalmoscopy
    c) Indirect ophthalmoscopy
    2) Slit lamp bio-microscopic examination by
    a) Indirect slit lamp bio-microscopy
    b) Hruby lens bio-microscopy
    c) Contact lens bio-microscopy
    THANK YOU

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