Assessment of the eye

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Assessment of the eye

History
l. Biographical &demographic data
·         Age    
·         Gender
·         Incidence of diseases of eye
2. Current health
·         Vision loss
·         Visual manifestations
  A. Chief complaint
·         Headache
·         Eye. strain
  B. Clinical manifestations
·         Pain
·         Abnormal vision
·         Abnormal appearance
·         Abnormal sensations
  3. Review of systems
A . Past health history
·         Ask about systemic illnesses like HTN, DM, cancer, RA, multiple sclerosis.
·         History of tests for visual acuity
 B. Surgical history
·         Cataract removal
·         ucoma treatment
  C. Allergies
·         Allergies to medications
·         Inhalants
·         Environmental contacts
  D. Medications
·         Over counter medications,       
·         Eye drops
 E. Dietary habits
·         Herbal therapies
·         Dietary supplementation
 F. Social History
·         Psychosocial history
·         Works &hobbies
·         Risk for eye or head trauma, foreign body injury etc
  G. family health history
·         Eg: glaucoma, myopia, hyperopia, DM
          
Ask about the following points:
eye pain, photophobia or redness: 'Have the eyes been red, uncomfortable or painful?'
— Painful red eye, particularly with photophobia may be serious and due to: Iritis, corneal ulcer, acute glaucoma
— painless red eye may be: episcleritis, syslemic vasculilis
— sticky red eye may be conjunctivitis (usually infective)
— itchy eye may be allergic, e.g. allergic rhinitis
            — gritty eye be dry (sicca or Sj√∂gren 's syndrome)
clarity of vision: 'Has your vision been blurred?'
— blurring of vision for either near or distance
— loss of central vision (or of top or bottom half) in one eye may be due to a retinal or  optic nerve disorder
 — Transient complete blindness in one eye lasting for minutes — amaurosis fugax (fleeting blindness) suggests retinal arterial blockage from embolus may be from carotid atheroma
— subtle difficulties with vision, difficulty reading — problems at the chiasm, or visual path behind it:
complete bitemporal hemianopia — tumour pressure on chiasm homonymous hemianopia: posterior cerebral or optic radiation lesion
— usually infarct or tumour; rarely complains of 'half vision', but may have difficulty reading
            Diplopia: 'Have you ever seen double?' Diplopia may be due to:
— lesion of the motor cranial nerves III, IV or VI — third-nerve palsy causes double vision in all directions often with-dilatation of the pupil and ptosis —,
fourth-nerve palsy causes doubling looking down and in (as when reading) with images separated horizontally and vertically and tilted (not parallel) —
,
sixth-nerve palsy causes horizontal, level and parallel doubling worse on looking to the affected side — muscular disorder
e.g. thyroid-related myasthenia gravis (weakness after muscle use, antibodies to nerve end-plates)


Eye examination 
Inspection
·         Visual actuity 20/20
·         Eyebrows full, mobile
·         Eye lashes curve out &away from eyelids
·         Ptosis absent
·         Eyelids without lesions or inflammation
·         Eyes moist
·         Palpebral conjunctivae pink
·         Bulbar conjunciva clear
·         Scleral color even, without redness
·         Corneal light reflection symmetrical
·         PERRLA, directly &consensually
·         Cornea smooth
·         Corneal light reflexion
·         Lens &anterior chamber clear
·         Irises evenly colored
·         EOMs (extra ocular movements) full, without nystagmus             No strabismus
·         Visual fields full to confrontation
 Palpation
·         Eyeballs firm
·         Orbits without edema
·         No regurgitation from puncta (are tiny openings along the eyelid margin through   which tears drain)
·         Tenderness absent over lacrimal apparatus
            Fundoscopic examination
·         AV ratio approximately 2;3 (The ratio of the diameter of the retinal arteries to that of the retinal veins. It is usually around two-thirds.)
·         Vessels without tortuosity, narrowing, pulsations or nicking
·         Disc margins clear, no cupping
·         No evidence of retinal haemorrhage, patches, spots
  Visual testing
1.         visual acuity
·         Determines clarity of cornea, lens &vitreous
·         Position client 20 ft distance form snellen chart Interpretation
·         20/20 is normal
·         20/30 &more is myopia (near sightedness)
·         20/15 &less is hyperopia (far sightedness)
·         20/200 is blindness
2.         Visual fields
·         To evaluate peripheral vision
·         By using computerized equipment
·         Done by ophthalmologist
·         Gross visual abnormalities can be detected.
3.Special tests
Color vision
·         Problems are genetic
·         Test involves use of color plates with numbers outlines in primary colors surrounded by confusion colors

Normanl IOP: 10-20mmHg, Tonometry – measuring the IOP

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notes.nursium.com: Assessment of the eye
Assessment of the eye
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