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Symptoms of Eye

Disease
Samantha Watkins BOptom (Hons)
PhD Student
Department of Ophthalmology 2015
HISTORY
A careful history will:
Suggest the disease & its cause
Direct your clinical examination
Direct your investigations
Place the problem in the context of the patient and
their circumstances as a whole
Allows a comprehensive management plan
HISTORY
Standard format:

Presenting complaint
History of presenting complaint
Systemic enquiry
Past ocular history
Past medical history
-medications & allergies
Family history
Social History
HISTORY OF
PRESENTING COMPLAINT:
SYMPTOM CHARACTERISTICS
Site
Onset
Duration
Severity
Relieving or exacerbating factors
Associated symptoms
PRESENTING COMPLAINT:
SYMPTOM GROUPS
Grittiness, burning, itch, sharp pain,
Anterior watering, discharge, redness
Eye Blurred vision, photophobia

Loss of vision, distortion of vision


Posterior
Floaters, flashers, field defect
Eye Deep achey pain, redness

Orbit Diplopia, ptosis, ache


PAIN
S.O.C.R.A.T.E.S
Grittiness, burning, foreign body sensation
ocular surface
Itch allergies
Periocular Ache assoc with redness:
& photophobia uveitis
& haloes/blur acute glaucoma
& chemosis/lid swelling orbital cellulitis
Ache at temple giant cell arteritis
Systemic enquiry
Consider referred pain
PHOTOPHOBIA
= light sensitivity

Usually due to
Keratitis
or uveitis (anterior chamber inflammation
affecting pupil movement)
Keep in mind meningitis
RED EYE

Unilateralvs. bilateral
Associated symptoms
Pain
Vision affected
Discharge

Circumstances e.g trauma, coughing


Systemic symptoms
DISCHARGE
Purulent Bacterial

Mucopurulent Chlamydia

Mucoid Allergic

Watery Viral
CASE EXAMPLE
22 yo Male 3/7 history of painful red watery,
photophobic eye

Cold sores on my
nose when I
started my exams

Ulcers as a child
VISION LOSS
Sudden vs. gradual
Intermittent vs. constant
Unilateral vs. Bilateral
Blur vs. field defect vs. complete blackness
Field defect: central vs. peripheral
Distortion: wavy lines
Associated symptoms e.g. headache, haloes,
pain
VISION LOSS
Transient: returns to normal within 24hrs
Few seconds papilloedema,GCA
Few mins TIA
15-60 mins migraine (+positive symptoms)
Visual loss >24 hours
Sudden painless retinal artery or vein occlusion,
retinal detachment, vitreal haem
Gradual painless cataract, refractive error, chronic
retinal problem
Painful angle closure glaucoma, optic neuritis,
uveitis
CASE EXAMPLE
56 yo Man with 5/7 painless blurred vision right eye
Top half of my vision is gone
I had episodes of complete
loss of vision twice previously

On further questioning:
CABG 1997
Smokes 20/day
FH of hyperlipidaemia
FLASHES & FLOATERS

Flashes originate from stimulation of the


neurosensory retina by traction from the vitreous
Floaters due to degeneration of the vitreous
Sudden onset suggest a posterior vitreous
detachment.
Large red/brown floaters or a drop in vision
suggests vitreous haemorrhage
DOUBLE VISION
Two images are seen (true diplopia vs. ghosting)
Monocular or binocular
Where are they relative to each other?
Horizontal/vertical/oblique
Constant or variable
DOUBLE VISION
Onset e.g after head injury, pain when moving the
eye orbital wall fracture
Associated symptoms e.g headache/other cranial
nerve defects imaging
Past history e.g of squint can decompensate
later in life
Systemic enquiry e.g diabetic, myasthenia gravis,
hyperthyroidism
PAST OCULAR HISTORY
Spectacle wear
myope
hypermetropia
presbyopia
Contact lens wear
Squint or amblyopia
Surgery or trauma
PAST MEDICAL HISTORY
Vascular history if acute visual loss
Rheumatological history in patients with uveitis
Diabetes
Neurological problems
Previous Cancer
Constitutional symptoms
Polymylagia Rheumatica
MEDICATIONS & ALLERGIES
Give you an idea of the
patients general state
of health
Remember systemic
medications have
ocular effects
Ocular medications
have systemic effects
FAMILY HISTORY

Glaucoma
Squint
Poor vision
Macular
Degeneration
Keratoconus
Retinal
Detachment
SOCIAL HISTORY
Occupation
Driving
Independence (particularly for elderly)
Smoking
Alcohol
QUESTIONS