Basic Ophthalmology (Grade A)

Summary:

The condensed notes provide an overview of the key points to consider when taking a patient’s history in ophthalmology. It covers different aspects of vision loss, such as gradual versus acute onset, and provides a differential diagnosis for various conditions. The notes also discuss associated ocular symptoms, general medical history, past ocular history, history of trauma, and specific symptoms like red eyes, diplopia, and discharge. It highlights the importance of considering factors like refractive state, family history, allergies, and commonly associated symptoms. The notes provide references for further information on ophthalmology history taking.

Excerpt:

Basic Ophthalmology

Past Ocular History
The refractive state of eyes may associate with certain pathologies.
Myopia: retinal detachment/ early-onset vitreous degeneration
Hyper myopia: acute angle closure glaucoma/pseudo papilledema

Family history
Predispose to Acute Open Angle Glaucoma & Presenile Cataract

Allergies
Topically applied drugs and their delivery vehicles and preservatives may stimulate an allergic
reaction, which should be considered in a patient with a persistent red eye.

Commonly associated symptoms:

Floaters: due to vitreous degeneration (in the elderly and myopes). If associated with a reduction in vision (vitreous haemorrhage). Floaters can also be due to inflammatory cells in the vitreous (posterior uveitis, iritis (rare) )
Flashers: due to acute posterior vitreous detachment
Proptosis: Most common cause: Thyroid dysfunction (ask for systemic symptoms),
Pseudoproptosis (High myopia/Enopthalmos), Reduction in vision (refer specialist)

…

Irritable eyes :
1) Dry Eyes: Worse in warm dry atmospheres, female elderly patients, attack towards the end of the day
2) Blepharitis: Worse in the morning, sticky lid, rusty

General Medical History
– Connective Tissue Disease: RA associated with dry eyes
– Thyroid Disorder
– History of Atopy: Atopic/Allergic Keratoconjunctivitis
– Acne Rosacea: Rosacea Keratoconjunctivitis

Past Ocular history
– Use of contact lens
– Any allergies or sensitivity to topical medication
– If the complaint of irritable eyes assoc. with visual loss (refer to differentials for acute/chronic visual loss)

References :
1. Ophthalmology Toronto Notes 2011
2. Mark Butterbury Ophthalmology Notes 3rd edition