history taking in ophthalmology
DESCRIPTION
history taking lecture from RCSITRANSCRIPT
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History taking in History taking in ophthalmologyophthalmology
HistoryHistory A good history commonly leads to A good history commonly leads to
a diagnosisa diagnosis Helps you focus your examinationHelps you focus your examination Indicates when/what Indicates when/what
investigations are neededinvestigations are needed Helps determine the functional Helps determine the functional
impact of the conditionimpact of the condition
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HistoryHistory Record age and genderRecord age and gender Presenting complaintPresenting complaint History of presenting complaintHistory of presenting complaint Past ophthalmic historyPast ophthalmic history Past medical historyPast medical history MedicationsMedications Family historyFamily history AllergiesAllergies Social historySocial history
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HistoryHistory
Presenting complaintPresenting complaint
History of presenting complaintHistory of presenting complaint How long?How long? Involving one or both eyes?Involving one or both eyes? Any associated symptoms?Any associated symptoms? Any similar problems before?Any similar problems before?
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Presenting complaintsPresenting complaints
Visual disturbance Visual disturbance PainPain Red eyeRed eye DischargeDischarge Itchy/dry/gritty eyesItchy/dry/gritty eyes Alteration in appearanceAlteration in appearance
Ptosis, lid swelling, squintPtosis, lid swelling, squint
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Past ocular historyPast ocular history
Previous eye problemsPrevious eye problems Refractive errors (myopia, Refractive errors (myopia,
hyperopia, astigmatism)hyperopia, astigmatism) Ocular surgeryOcular surgery Ocular traumaOcular trauma SquintSquint Lazy eyeLazy eye
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Past medical historyPast medical history
Diabetes?Diabetes? Hypertension?Hypertension? Rheumatoid arthritis?Rheumatoid arthritis? Sarcoidosis?Sarcoidosis? Asthma?Asthma? Eczema or other skin problems?Eczema or other skin problems? Other Other
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MedicationsMedications
Present and pastPresent and past
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AllergiesAllergies
AntibioticsAntibiotics Hay feverHay fever Any other medicationAny other medication
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Family historyFamily history
SquintSquint GlaucomaGlaucoma MyopiaMyopia CataractsCataracts Poor vision etc.Poor vision etc.
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Birth historyBirth history
For children onlyFor children only PrematurityPrematurity Forceps deliveryForceps delivery Low birth weightLow birth weight
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Social historySocial history
SmokingSmoking AlcoholAlcohol OccupationOccupation Home circumstancesHome circumstances
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Central retinal artery occlusion, note- pale posterior pole (fromischaemia and retinal oedema) red macula (due to choroidal circulation visable through thinnest part of the retina at macula )
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Central retinal vein occlusion
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Proliferative diabetic retinopathy
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Inferior retinal Inferior retinal detachmentdetachment
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Retinitis pigmentosa Leads to lossof peripheralvision and night blindnessNote pale disc, attenuated vessels and pigmentary changes in the periphery.
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Pan retinal photocoagulation for diabetic retinopathy
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Swollen disc from ischaemic optic neuropathy
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Neovascular age related macular degeneration
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Acute angle closure glaucoma
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Acute angle closure glaucomaAcute angle closure glaucomaNote red conjunctiva, hazy cornea due to corneal oedema, Note red conjunctiva, hazy cornea due to corneal oedema, dilated pupil. dilated pupil.
This patient will have a very hard eye.This patient will have a very hard eye.
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Dendritic ulcerDendritic ulcer
Note branching pattern of stainjng with Note branching pattern of stainjng with fluorescein under blue ultra violet lightfluorescein under blue ultra violet light
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PtosisPtosis
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ExophthalmosExophthalmosNote – lid retraction on rightNote – lid retraction on right
also bilateral cataracts also bilateral cataracts as greyish colour in pupils as greyish colour in pupils and bilateral arcus senilis and bilateral arcus senilis (white rings around margins of (white rings around margins of both corneas)both corneas)
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Corneal ulcer and hypopion
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