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

Thank you!