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eye cases: how?. DR. PRANAV BHAGWAT DR. JIJITH C.R. HISTORY TAKING. Allow patient to tell story. Decreased vision. Ask for Onset Duration Uni / Bilateral Distant or near vision Whether the patient wears glasses Diurnal variation. Sudden unilateral loss of vision.
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eye cases: how? DR. PRANAV BHAGWAT DR. JIJITH C.R.
HISTORY TAKING • Allow patient to tell story.
Decreased vision Ask for • Onset • Duration • Uni / Bilateral • Distant or near vision • Whether the patient wears glasses • Diurnal variation
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
Sudden bilateral loss of vision • Acute methanol toxicity • Hysteria
Reduced vision in the morning, improved in afternoon • Intermittent corneal edema
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 Gradual onset loss of vision
Pain in the eye • Type • Onset • Duration • Diurnal variation • Associated complaints e.g., nausea, vomiting, DV
Severe eye pain • Adhimantha • K abrasions and ulcers • Acute iridocyclitis • Panopthalmitis • Acute glaucoma • Scleritis • Episcleritis
Dull Aching pain • Cases with eye strain
Mild eye pain • Corneal FB • Conjunctival FB • Conjunctivitis
Pain around the eye • Pathology of the lid and lacrimal apparatus (eg: stye)
Normal eye lid with normal corrected visual acuity • Conjunctivitis • Keratitis • Corneal ulcer • Arjuna • Episcleritis
Abnormal eye lid with normal corrected visual acuity • Ectropion • Entropion • Stye • Blepharitis
Reduced corrected visual acuity without diplopia • Iritis • ACG • K foreign body • K ulcer
Reduced corrected visual acuity with diplopia • Carvernos sinus thrombosis • Orbital cellulitis • Caratico carvernos fistula
Photophobia • Acute infective or inflammatory lesion of the anterior segment • Recently operated eyes
Watering of the eyes 1)Excessive lacrimation • Keratitis • Uveitis • Glaucoma 2) Epiphora • Mechanical obstruction to drainage- stricture, punctal stenosis & chronic dacryocistitis • Defective orbicularis action
Discharge • Watery-Mild bacterial infection • Serous -viral • Mucoid -mild conjunctivitis • Mucopurulent & purulent- acute pyogenic infection of anterior segment • Serosanguinous- opthalmia neonatrum
Itching • Allergic disoders- phlycten • Episcleritis • Spring catarrh • Allergic blepharo conjunctivitis
Netra daaha • Pittotklishta • Pittaja abhishyanda • Pitta vidagdha drishti.
Foreign body sensation • Presence of FB • Distorted eye lashes- trichiasis, entropion • Conjunctival concretion, calcification • Contact lenses
Black spots in front of eyes • 1) Stationary K scars, lens opacity • 2) Mobile- Vitreous opacities
Headache • Refractive errors • Improperly corrected refractive errors • Zoster
Haloes around light • 1) Early ACG • 2) Acute mucopurulent conjunctivitis • 3) Early stages of cataract
Photopsiae • Irritative lesions of retina • Impending RD
Diplopia • 1) Unioccular- high K astigmatism, subluxated or dislocated lens • 2) Binocular- Squint
Nyctalopia • Vitamin A deficiency • Retinitis pigmentosa • Pathological myopia • Glaucoma
Occupation • Welders • Black smiths- foreign body in the eye • Farmers- fungal keratitis
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
Past history • Systemic diseases- diabetis mellitus • Arjuna-HT • Iritis- ankylosing spondylitis
History of previous ocular disease • Childhood squint- lazy eye • Blunt injury- traumatic mydriasis ( could be confused with partial third nerve palsy)
Family history • Chronic glaucoma- the incidence nearly 5 times greater in siblings and children of affected patients
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
Jaeger’s test type • N5 to N48
Visual field • 1) Peripheral field- confrontation or perimeter • 2) Central field by scotometery
Colour vision • Ishiahara chart
Ocular and periocular examination • 1) Head posture- Paralytic squint.
Face • Look for • Asymmetry • Signs of paralysis • Obvious skin changes
Orbit • Inspection and palpation
Eye brows • Look for loss of hair- lepromatous leprosy, myxoedema • Depigmentation
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
Pakshma mandal • Trichiasis- misdirection of lashes • Distichiasis- double row • Madarosis- scantiness • Matting- conjunctivitis
Shuklamandal (conjunctiva & sclera) • 1) Bulbar conjunctiva a) congestion- ciliary/conjunctival
b) Chemosis- c) Subconjunctival haemorrhage d) Pigmentation e) Nodule