Date post: | 25-Dec-2015 |
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Decreased vision
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• 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
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
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
Normal eye lid with normal corrected visual acuity
• Conjunctivitis
• Keratitis
• Corneal ulcer
• Arjuna
• Episcleritis
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
Foreign body sensation
• Presence of FB
• Distorted eye lashes- trichiasis, entropion
• Conjunctival concretion, calcification
• Contact lenses
Haloes around light
• 1) Early ACG
• 2) Acute mucopurulent conjunctivitis
• 3) Early stages of cataract
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
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
Eye lid
• 1) Position of the lid margin in relation to cornea- drooping of lids
• 2) Thickness of the lid• 3) Swelling
a) Localised eg) Stye, chalazion
b) Generalised- Oedema,ecchymosis
Pakshma mandal
• Trichiasis- misdirection of lashes
• Distichiasis- double row
• Madarosis- scantiness
• Matting- conjunctivitis
Upper tarsal conjunctiva
• Congestion
• Alteration of normal vertical vascular pattern
• Follicle/papilla
Krishnamndal (cornea & iris)
• Cornea
• 1) Size- normal (12 to 13 mm)
• 2) Curvature-conical / globular / flat
• Irregular surface- corneal ulcer, scarring
• Depression / corneal facets
• Elevation- epithelial bulla
• Opacity
• 1) density- nebula / macula / leucoma
• 2) Situation and extent in relation to pupil
• 3) Iris adhesion
• Corneal sensationsDiminished sensation- • Herpes• 5th nerve paralysis• ACG and absolute glaucoma• Leprosy• Prolonged use of contact lens• Post surgery• Local anaesthesia
Iris
• 1) Iris pattern
• 2) Colour
• 3) Vessels- visible = patho.
• 4) Atropic patches = end stage of glaucoma
Pupil
• Size- (3 to 4mm)
• Shape
• Position
• Pupillary margin
• Pupillary aperture
• Pupil reaction