Assessment of the eye

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 Sjögren '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