Download Symptoms of Eye Disease

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
Anterior
Eye

Posterior
Eye

Orbit

Grittiness, burning, itch, sharp pain,
watering, discharge, redness
Blurred vision, photophobia

Loss of vision, distortion of vision
Floaters, flashers, field defect
Deep achey pain, redness

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
 Unilateral
vs. 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
patient’s 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