Signs of Eye Disease
Associate Professor Dipika Patel Department of Ophthalmology
Major issue with triage
• Is this serious? • Is this non-urgent? • Does it need referred? • Can I deal with it myself?
Is this serious?
Is this serious?
Need a system!
Examination
• Step back: look at overall patient – Is this a sick patient?
• Step back: look at face
– Is this an eye problem, or skin problem?
Examination • Visual acuity
• Lids and anterior segment
• Fluorescein
• Intraocular pressure
• Colour vision
• Visual fields
• Eye movements
• Pupil reactions
• Fundus
Visual acuity
Visual acuity
Distance patient read chart
Line read
6/60 6/18 6/6 6/4
Visual Acuity Options
Visual Acuity
Lids • Able to open? • Position • Colour • Tender?
Remember the brain!
Fluorescein
• Stains epithelial defects
• Assessing tear film
• Detecting leaks
• Checking intraocular pressure
Every red eye needs dye…
Conjunctiva
• Colour? • Distribution?
Cornea • Colour: Clear/Opaque • Staining • Foreign body? • SubTarsal
Anterior Chamber • Deep/normal? • Shallow/collapsed? • Blood – hyphaema • Pus/White cells -
hypopyon
Intraocular pressure
Goldman tonometry
IOP Assessment
Visual fields
• Test on confrontation
Normal field
Visual field defects
Hemianopia
Visual field defects
Quadrantanopia
Visual field defects
Central scotoma
Visual field defects
Tunnel vision
Visual field defects
Eye movements
Pupil reactions
• Responses to light • Direct • Consensual
• RAPD
• Response to accommodation
Tools of the trade
Fundus examination
• Must dilate pupils
• Tropicamide eye drops
Red reflex
Present / reduced?
Fundus examination
•Don’t be shy! •Remember to
breathe!
Fundus examination
• Monocular
• Erect image (upright)
• High magnification (x 15)
• Restricted field of view (7 - 8°)
• Provides view to the arcades
Don’t forget the brain!
Summary
• Don’t panic: take your time • Measure visual acuity • Check pupils • Work through structures (front to back) • Every red eye needs dye (fluorescein) • Think: emergency/urgent/soon/routine