HISTORY AND PHYSICAL EXAM OF THE EYE. HO.ppt

HISTORY AND PHYSICAL EXAM OF THE EYE for Health officers.ppt

1. Aemero Abateneh. (M.D)
Ass. Professor of Ophthalmology
Jimma University Department of Ophthalmology
June 2015

2. 2September 23, 2024

3. At the conclusion of this presentation, the student
should be able to:
Take appropriate ocular and systemic history
concerning eye problems.
Understand how to perform the basic eye exam
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4. Chief complaints
“basic questions” — when did it start,
what’s it like, is there anything that
makes it better or worse, are you taking
any medications for relieve, …
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5. Transient vision loss:
Migraine, micro-emboli,
Curtains of darkness>> ischemic event or a
retinal detachment
Blurry vision: Is the vision always blurry?
Does it worsen when reading or watching
TV? >>dry eye
Is this a glare problem at night>> cataracts?
diabetic patient with poor control >>
hyperglycemic swelling of the lens?
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6. Red, painful eyes:
nature of the pain (is this a scratchy pain,
aching pain, or only pain with bright light). Is
there discharge that might indicate an
infection?
Chronic itching and tearing: >> allergies or
blepharitis. Is it in both eyes?
Headaches and scalp tenderness: >>
temporal (giant cell) arteritis >> ask about other
collaborating symptoms like jaw claudication,
polymyalgias, weight loss, and night sweats.
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7. Visual reduction
Progressive/sudden, painful/non-painful
Diplopia
Monocular / binocular >> ?Squint, nerve
palsies
Proptosis
Tumors, orbital cellulitis
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8. Diabetes
Hypertension
coronary artery disease
thyroid problems
asthma
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9. past clinic visits and surgeries
cataract surgeries
eye trauma
glaucoma.
Check eyedrop bottles the patient is using
Spectacle use
Laser treatments for Diabetic retinopathy.
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10. history of glaucoma and blindness.
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11. Allergy history
Rhinitis, dermatitis, asthma
Allergy to meds
Medications:
what eyedrops your patient is taking, and why.
Are they using a regular eyedrop?
Did they bring their drops with them?
bottlecap-color of their drops (ex. all dilating drops
have red caps).
if your patient is taking an oral beta-blocker already, in
case you want to start a beta-blocking eyedrop.
Side effects: eg. Steroids >> cataract and glaucoma
Drug interactions
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12. The tools:
visual acuity chart (can be your near card)
near card (has pupil sizes & ruler)
bright light (can use your direct ophthalmoscope)
direct ophthalmoscope
Tonometer
slit lamp
eye drops: topical anesthetic, fluorescein dye, dilating
drops
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13. *
*
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14. Visual acuityVisual acuity
PupilsPupils
Intraocular pressureIntraocular pressure
Alignment & Motility
Visual fields (VF)
External exam: lids and lashes,
conjunctiva, sclera, cornea, anterior
chamber, iris, lens
Dilated fundoscopic exam (DFE): vitreous,
optic nerve, vessels, macula, periphery
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15. Typically measured by Snellen acuity
but there are many optotypes (letters,
tumbling E, pictures)
conventionally tested at 6 meter/ 20
feet
Recorded as fraction (numerator is
testing distance, denominator is
distance at which person with normal
vision would see figure)
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16. Measured without & without glasses
(V/A cc & V/A sc), want to know best
corrected acuity
Occlude one eye, children need to be
patched
6/6 to 6/60, CF (counting fingers), HM
(hand motion), LP (light perception),
NLP (no light perception)
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18. The pinhole (PH) exam can show
refractive error
Need a pinhole occluder
Central rays of light do not need to be
refracted
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19. Pupil size - measure with pupil gauge on near card
Anisocoria should be recorded under bright and
dim light (greater than 1 mm is abnormal)
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20. Relative afferent pupillary defect (RAPD)
or Marcus Gunn pupil
Detected with swinging flash light test
Indicates unilateral or asymmetric
damage to anterior visual pathways
(optic nerve or extensive retinal
damage)
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22. monocular or binocular??
monocular diplopia: If, after covering an
eye, the vision stays doubled.
refractive error such as astigmatism, cataract,
or corneal surface problems (dry eye,
keratitis…)
Binocular diplopia : covering one eye
abolishes diplopia
a misalignment between the eyes
▪neuromuscular paralysis or muscle restriction (e.g.
muscle entrapment after trauma).
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23. Strabismus is misalignment of the eyes
Important to recognize in children to prevent
development of amblyopia
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24. Normal or
straight
Exotropia (out)
Esotropia (in)
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25. Elevation, depression, abduction, adduction
0
0
0
0-3
-1
-1
-3
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27. Measured by tonometer or palpation
Varies throughout the day, normal is
10-22
Palpation may be useful if you suspect
angle closure glaucoma (never perform
in trauma!)
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28. Symmetry
ptosis (drooping of the eye)
proptosis (extruding eyes or “bull’s-
eyes”).
pre-auricular nodes (in front of the ear)
and sub-mandibular/mental nodes.
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29.  Lid margin and lashes
Collarettes, scruffs on eyelashes? >Blepharitis,
poliosis, madarosis
Matted eyelashes with discharge? Type of
discharge?
Trichiasis
Evert the lids to look for follicles or
papillae
Patency of the puncta
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30. Sclera
Icteric?
Pigmented?
Conjunctiva :
Follicles, papillae, scar, mass?
Injected?
Pale?
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31. erosions and abrasions ?trauma
Ulcers? Fluorescein dye (orange pigment
turning into yellowish green) will make
surface epithelial defects easier to spot.
Scar? Vascularization?
Does the stroma look hazy? Edema?
Infiltrates?
endothelial surface for folds or gutatta,
Keratic precipitates, pigments
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32. cell and flare, indicate inflammation
Hyphema? Blood in AC
Depth:
deep and well-formed, or shallow and thus
a setup for angle-occlusion glaucoma.
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33. Flat?, bulged?
pupil round?.
Anterior synechia, posterior synechia?
diabetes or an old retinal vascular
occlusion>>neovascularization of the iris.
Heterochromia Iridis
Horner’s syndrome (Hypopigmentation),
latanoprost eye drop use (Hyperpigmentation)
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34. Is the lens clear, or hazy with cataract?
Are they phakic (they have their own
lens), pseudophakic (prosthetic lens), or
aphakic (no lens at all)?
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35. Disk
Is the margin sharp or blurred? >> ?
papilledema, papillitis…
What’s the cup-to-disk ratio? Large?>> ?
glaucoma
Do the rims look pink and healthy or pale?
>> ?Optic atrophy
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36. Right eye of examiner – right hand of
examiner – right eye of patient
Upright image
15x magnification
Field of view small :
10 degrees
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