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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.

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eye cases how

eye cases: how?

DR. PRANAV BHAGWAT

DR. JIJITH C.R.

history taking
HISTORY TAKING
  • Allow patient to tell story.
decreased vision
Decreased vision

Ask for

  • Onset
  • Duration
  • Uni / Bilateral
  • Distant or near vision
  • Whether the patient wears glasses
  • Diurnal variation
sudden unilateral loss of vision
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
Sudden bilateral loss of vision
  • Acute methanol toxicity
  • Hysteria
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

Gradual onset loss of vision
pain in the eye
Pain in the eye
  • Type
  • Onset
  • Duration
  • Diurnal variation
  • Associated complaints e.g., nausea, vomiting, DV
severe eye pain
Severe eye pain
  • Adhimantha
  • K abrasions and ulcers
  • Acute iridocyclitis
  • Panopthalmitis
  • Acute glaucoma
  • Scleritis
  • Episcleritis
dull aching pain
Dull Aching pain
  • Cases with eye strain
mild eye pain
Mild eye pain
  • Corneal FB
  • Conjunctival FB
  • Conjunctivitis
pain around the eye
Pain around the eye
  • Pathology of the lid and lacrimal apparatus (eg: stye)
normal eye lid with normal corrected visual acuity
Normal eye lid with normal corrected visual acuity
  • Conjunctivitis
  • Keratitis
  • Corneal ulcer
  • Arjuna
  • Episcleritis
reduced corrected visual acuity with diplopia
Reduced corrected visual acuity with diplopia
  • Carvernos sinus thrombosis
  • Orbital cellulitis
  • Caratico carvernos fistula
photophobia
Photophobia
  • Acute infective or inflammatory lesion of the anterior segment
  • Recently operated eyes
watering of the 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
Discharge
  • Watery-Mild bacterial infection
  • Serous -viral
  • Mucoid -mild conjunctivitis
  • Mucopurulent & purulent- acute pyogenic infection of anterior segment
  • Serosanguinous- opthalmia neonatrum
itching
Itching
  • Allergic disoders- phlycten
  • Episcleritis
  • Spring catarrh
  • Allergic blepharo conjunctivitis
netra daaha
Netra daaha
  • Pittotklishta
  • Pittaja abhishyanda
  • Pitta vidagdha drishti.
foreign body sensation
Foreign body sensation
  • Presence of FB
  • Distorted eye lashes- trichiasis, entropion
  • Conjunctival concretion, calcification
  • Contact lenses
black spots in front of eyes
Black spots in front of eyes
  • 1) Stationary

K scars, lens opacity

  • 2) Mobile- Vitreous opacities
headache
Headache
  • Refractive errors
  • Improperly corrected refractive errors
  • Zoster
haloes around light
Haloes around light
  • 1) Early ACG
  • 2) Acute mucopurulent conjunctivitis
  • 3) Early stages of cataract
photopsiae
Photopsiae
  • Irritative lesions of retina
  • Impending RD
diplopia
Diplopia
  • 1) Unioccular- high K astigmatism, subluxated or dislocated lens
  • 2) Binocular- Squint
nyctalopia
Nyctalopia
  • Vitamin A deficiency
  • Retinitis pigmentosa
  • Pathological myopia
  • Glaucoma
occupation
Occupation
  • Welders
  • Black smiths- foreign body in the eye
  • Farmers- fungal keratitis
medication
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
Past history
  • Systemic diseases- diabetis mellitus
  • Arjuna-HT
  • Iritis- ankylosing spondylitis
history of previous ocular disease
History of previous ocular disease
  • Childhood squint- lazy eye
  • Blunt injury- traumatic mydriasis ( could be confused with partial third nerve palsy)
family history
Family history
  • Chronic glaucoma- the incidence nearly 5 times greater in siblings and children of affected patients
visual acuity
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
visual field
Visual field
  • 1) Peripheral field- confrontation or perimeter
  • 2) Central field by scotometery
colour vision
Colour vision
  • Ishiahara chart
ocular and periocular examination
Ocular and periocular examination
  • 1) Head posture-

Paralytic squint.

slide44
Face
  • Look for
  • Asymmetry
  • Signs of paralysis
  • Obvious skin changes
orbit
Orbit
  • Inspection and palpation
eye brows
Eye brows
  • Look for loss of hair- lepromatous leprosy, myxoedema
  • Depigmentation
eye lid
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
Pakshma mandal
  • Trichiasis- misdirection of lashes
  • Distichiasis- double row
  • Madarosis- scantiness
  • Matting- conjunctivitis
shuklamandal conjunctiva sclera
Shuklamandal (conjunctiva & sclera)
  • 1) Bulbar conjunctiva

a) congestion- ciliary/conjunctival

slide50
b) Chemosis-

c) Subconjunctival haemorrhage

d) Pigmentation

e) Nodule

upper tarsal conjunctiva
Upper tarsal conjunctiva
  • Congestion
  • Alteration of normal vertical vascular pattern
  • Follicle/papilla
slide52
Scarring
  • Membrane formation
  • Granuloma
  • Foreign body
lower tarsal conjunctiva
Lower tarsal conjunctiva
  • As above + any sign of symblepheron
staining
Staining
  • 2% fluorescein- raw area- green
  • 1% rose bengal- conjunctiva- pinkish red
sclera
Sclera
  • Colour change
  • Pigmentation
  • Protrusion of uveal tissue
  • Congestion
  • Nodule formation
krishnamndal cornea iris
Krishnamndal (cornea & iris)
  • Cornea
  • 1) Size- normal (12 to 13 mm)
  • 2) Curvature-conical / globular / flat
slide58
Irregular surface- corneal ulcer, scarring
  • Depression / corneal facets
  • Elevation- epithelial bulla
slide59
Opacity
  • 1) density- nebula / macula / leucoma
  • 2) Situation and extent in relation to pupil
  • 3) Iris adhesion
slide60
Pannus (sirashuklam)-
  • Keratic precipitates
slide61
Corneal sensations

Diminished sensation-

  • Herpes
  • 5th nerve paralysis
  • ACG and absolute glaucoma
  • Leprosy
  • Prolonged use of contact lens
  • Post surgery
  • Local anaesthesia
slide63
Iris
  • 1) Iris pattern
  • 2) Colour
  • 3) Vessels- visible = patho.
  • 4) Atropic patches = end stage of glaucoma
slide64
Defect in the iris
  • Iridodonesis- aphakia / buphthalmos
  • Iridodyalisis
  • Anterior synechia
slide65
Anterior chamber

Depth and content

pupil
Pupil
  • Size- (3 to 4mm)
  • Shape
  • Position
  • Pupillary margin
  • Pupillary aperture
  • Pupil reaction
slide67
Lens
  • Colour
  • Opacity
  • Position
pakshmavarthmagathasanthi
Pakshmavarthmagathasanthi
  • Entropion
  • Ectropion
  • Tylosis
  • Milphosis
kaneenika sandhi
Kaneenika sandhi
  • Lacrimal puncta- eversion / stenosis / absence
  • Skin around it