Basic Case History

Primary Eye CareOD-104

Sahibzada Hakim Anjum NadeemDepartmental Coordinator,Department of Optometry and Vision Sciences CEO Anjum Eye Care & Optical CompanyOptometrist, Al-Khair Eye Hospital LahoreCo-Incharge OTTC, Optician, Refractionist, COAVSPhone:03344496480, Email: shanjum92@gmail.com

Common sight problems

It is a gathering information process from the patient guided by an educated and active mind.

It is a selective guided and progressive elicitation and recognition of significant information

History by skilled person can arrive at the proper diagnosis in 90% of patients.

It gives vital guidance for: (a) physical examination (b) laboratory work (c) Therapy

Failure to take history can lead to missing vision or life threatening conditions.

Chief complaint: ’’The patient’s own words’’

‘’she cannot see with the RE’’ You should not come to conclusion that her problem

is nearsightedness and write down “Myopia of RE”.

The patient needs will not be satisfied until he/she has received an acceptable explanation of the meaning of the chief complaint and its proper management.

History of the Present Illness:

Detailed description of the chief complaint to understand the symptoms and course of the disorder.

Listen and question and then write down in orderly sequence that make sense to you.

* The time sequence when, How fast, what order did events

occur? * Frequency, intermittency

* location, Laterality * Severity * Associated symptoms

* Documentation (old records, photo) e.g ptosis, proptosis, VII N palsy.

gradual painless decrease vision both eyes for 1y.

Sudden painless decrease vision RE for 10 min.

“cannot see with RE”!! ? Only distance vision blurred. ? Blind spot is present in the center of VF ? Right side of VF of the RE lost ? Right VF of both eyes lost ? A diffuse haze obscures the entire field of RE

Each of these has different diagnostic implicationMost pt. has difficulty providing precise and concise

description

Disturbances of vision: Blurred or decreased central vision Decreased peripheral vision. (glaucoma) Altered image size. (micropsia, macropsia, metamorphopsia). Diplopia (monocular, binocular) Floaters Photopsia (flash of light)

Color vision abnormalities. Dark adaptation problems. Blindness (ocular, cortical). Oscillopsia (shaking of images).

Ocular pain or discomfort: Foreign body sensation Ciliary pain (aching, severe pain in or around the eye, often

radiating to the ipsilateral forehead, molar area) Photophobia Headache Burning Dryness Itching: patient rub the eye vigorously (allergy) Asthenopia (eye strain)

Floaters and flashing lights: These are the classic symptoms of a retinal detachment and retinal tears, so ask EVERY patient about these symptoms. Most patients complain of some floaters - see if they’re actually new or have worsened recently.Transient vision loss: Think of migraine vessel spasm in the young and micro-emboli in the elderly. Curtains of darkness might indicate an ischemic event or a retinal detachment, so explore these symptoms in detail.Blurry vision: Is the vision always blurry? Does it worsen when reading or watching TV? People blink less when watching TV and develop dry eyes. Is this a glare problem at night that might indicate cataracts? Is this a patient with poor glycemic control with resulting hyperosmotic swelling of their lens?Red, painful eyes: A common complaint. Be sure to ask about the 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: Think about allergies or blepharitis. Is it in both eyes?Headaches and scalp tenderness: Think of temporal (giant cell) arteritis and ask about other collaborating symptoms like jaw claudication, polymyalgias, weight loss, and night sweats.

How to

prevent eye

infecti

on

An eye infection is usually caused by bacteria or a virus. Eye infections include styes, conjunctivitis, trachoma etc

and can occur in any age group.

Eye care for computer usersIf you are into a job that requires working on computers for long hours, do take off your eyes from computer at regular intervals and have an anti-glare screen set on your computer.

While working for long hours, look at distant objects either in your office or outside. Looking at a distant object and then returning to your task helps your eyes focus better.

Try taking such visual breaks for about 5 to 10 minutes every hour.

Have separate towels

Ensure that each member of your family has separate towels. Eye infections like trachoma and conjunctivitis are transmitted through common towels and handkerchiefs.

Don’t share eye make-up

Do not share your eye makeup kit and do not use eye makeup until the infection is fully cured. Sharing makeup means you are also sharing bacteria and thus giving an open invitation to eye infections.

Take antibiotics with prescription

If you are taking medicines or antibiotics to manage other health problems, take it with doctor’s prescription because some medicines might cause eye infection.

Wash your eyes frequently

Wash your eyes and eyelids with an eye scrub and fresh water properly. If washing it with a eye scrub is not possible, at least wash your eyes with fresh water at frequent intervals right through the day. Dirty eyelids can lead to an eye infection.

Have an eye-friendly diet

The foods you eat contribute to your eye health. A diet rich in fruits and vegetables and fish contributes directly by supplying certain vitamins, minerals and essential fatty acids to your eyes. So, follow a healthy diet and avoid too spicy and greasy foods.

Sharing eye-drops is a big NO

Do not share eye drops as it can also transmit eye infection from one person to another.

Protect your eyes

Always wear sunglasses when in the sun, wind, or cold to prevent eye irritation.

Keep your hands clean

We all touch our eyes many times a day. It’s best to always wash your hands before and after touching your eyes or face.

Take care while using contact lenses

You should follow a proper hygiene when using contact lenses.Never touch your contact lenses or your eyes unless you have already washed your hands properly with soap and water. Never share your contact lens equipment, containers, or solutions.

Minimise eye allergens

Keep your eyes healthy by getting rid of different allergens that may cause your eyes to get itchy and irritated. These may include things like dirty carpet, pets, pollen, fabrics such as sofas and curtains.

Questions?