DR. PRANAV BHAGWAT DR. JIJITH C.R. eye cases: how? DR. PRANAV BHAGWAT DR. JIJITH C.R.
HISTORY TAKING Allow patient to tell story.
Decreased vision Ask for 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
Sudden bilateral loss of vision Acute methanol toxicity Hysteria
Reduced vision in the morning, improved in afternoon Intermittent corneal edema
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
Dull Aching pain Cases with eye strain
Mild eye pain Corneal FB Conjunctival FB Conjunctivitis
Pain around the eye Pathology of the lid and lacrimal apparatus (eg: stye)
Redness of the eye
Normal eye lid with normal corrected visual acuity Conjunctivitis Keratitis Corneal ulcer Arjuna Episcleritis
Abnormal eye lid with normal corrected visual acuity Ectropion Entropion Stye Blepharitis
Reduced corrected visual acuity without diplopia Iritis ACG K foreign body K ulcer
Reduced corrected visual acuity with diplopia Carvernos sinus thrombosis Orbital cellulitis Caratico carvernos fistula
Common causes –red eye.
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
Netra daaha Pittotklishta Pittaja abhishyanda Pitta vidagdha drishti.
Foreign body sensation Presence of FB Distorted eye lashes- trichiasis, entropion Conjunctival concretion, calcification Contact lenses
Black spots in front of eyes 1) Stationary K scars, lens opacity 2) Mobile- Vitreous opacities
Headache Refractive errors Improperly corrected refractive errors Zoster
Haloes around light 1) Early ACG 2) Acute mucopurulent conjunctivitis 3) Early stages of cataract
Photopsiae Irritative lesions of retina Impending RD
Diplopia 1) Unioccular- high K astigmatism, subluxated or dislocated lens 2) Binocular- Squint
Nyctalopia Vitamin A deficiency Retinitis pigmentosa Pathological myopia Glaucoma
Occupation Welders Black smiths- foreign body in the eye Farmers- fungal keratitis
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
Past history Systemic diseases- diabetis mellitus Arjuna-HT Iritis- ankylosing spondylitis
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
Examination of the function of eye
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
Jaeger’s test type N5 to N48
Visual field 1) Peripheral field- confrontation or perimeter 2) Central field by scotometery
Colour vision Ishiahara chart
Ocular and periocular examination 1) Head posture- Paralytic squint.
Face Look for Asymmetry Signs of paralysis Obvious skin changes
Orbit Inspection and palpation
Eye brows Look for loss of hair- lepromatous leprosy, myxoedema Depigmentation
Eye lid 1) Position of the lid margin in relation to cornea- drooping of lids 2) Thickness of the lid 3) Swelling Localised eg) Stye, chalazion Generalised- Oedema,ecchymosis
Pakshma mandal Trichiasis- misdirection of lashes Distichiasis- double row Madarosis- scantiness Matting- conjunctivitis
Shuklamandal (conjunctiva & sclera) 1) Bulbar conjunctiva a) congestion- ciliary/conjunctival
b) Chemosis- c) Subconjunctival haemorrhage d) Pigmentation e) Nodule
Upper tarsal conjunctiva Congestion Alteration of normal vertical vascular pattern Follicle/papilla
Scarring Membrane formation Granuloma Foreign body
Lower tarsal conjunctiva As above + any sign of symblepheron
Staining 2% fluorescein- raw area- green 1% rose bengal- conjunctiva- pinkish red
Sclera Colour change Pigmentation Protrusion of uveal tissue Congestion Nodule formation
Krishnamndal (cornea & iris) 1) Size- normal (12 to 13 mm) 2) Curvature-conical / globular / flat
Surface- examine by window reflex / placido disc / slit lamp
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
Pannus (sirashuklam)- Keratic precipitates
Corneal sensations Diminished sensation- Herpes 5th nerve paralysis ACG and absolute glaucoma Leprosy Prolonged use of contact lens Post surgery Local anaesthesia
Corneal stains
Iris 1) Iris pattern 2) Colour 3) Vessels- visible = patho. 4) Atropic patches = end stage of glaucoma
Defect in the iris Iridodonesis- aphakia / buphthalmos Iridodyalisis Anterior synechia
Anterior chamber Depth and content
Pupil Size- (3 to 4mm) Shape Position Pupillary margin Pupillary aperture Pupil reaction
Lens Colour Opacity Position
Pakshmavarthmagathasanthi Entropion Ectropion Tylosis Milphosis
Kaneenika sandhi Lacrimal puncta- eversion / stenosis / absence Skin around it
Shuklakrishnagatha santhi Nodule Congestion
Tonometry tonopen Shiotz tonometer.
Fundoscopy
Ocular coherence tomography
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