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PATIENT SYMPTOMS AND CLINICAL SIGNS Module 7.1

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Page 1: 7.1_ICLC_PPT

PATIENT SYMPTOMS AND CLINICAL SIGNS

Module 7.1

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Copyright Notice

The IACLE Contact Lens Course (all formats) is the sole property of the International Association of Contact Lens Educators (IACLE) and is protected, without limitations, by copyright. By accessing this material, you agree to the following terms and conditions: You may only access and use the IACLE Contact Lens Course for personal or educational purposes. Any dissemination or sale of the IACLE Contact Lens Course, either in whole or in part, or use of the materials for other than educational and personal purposes, is strictly prohibited without the express written consent of IACLE. Except as declared below, you may not reproduce, republish, post, transmit, or distribute any material included in the IACLE Contact Lens Course. You may print materials for personal or educational purposes only. All copyright information, including the IACLE logo, must remain on the material. Appropriate reference must be provided to any use of the content of the IACLE Contact Lens Course, including text, images, &/or illustrations.

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SPONSORS

Development and delivery of contact lens education by IACLE is supported through educational grants and in-kind contributions

Major In-Kind Supporters

Industry Supporters

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Published in Australia by The International Association of Contact Lens Educators

First Edition 1997 ©The International Association of Contact Lens Educators 1996

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior

permission, in writing, of: The International Association of Contact Lens Educators

IACLE Secretariat, PO Box 656

Kensington NSW 1465 Australia

Email: [email protected]

Acknowledgments in full can be found on our website: www.iacle.org

ACKNOWLEDGEMENTS

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CONTRIBUTORS

Patient Symptoms And Clinical Signs: Robert Terry, BOptom, MSc

Lewis Williams, AQIT(Optom), MOptom, PhD

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HISTORY TAKING

•  Key to solving most problems

•  Pertinent and probing initial questions

– how, what, where, when and why?

•  Open-ended questions (open probing)

•  Listen to the wearer’s own words

•  Follow-up questions

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HISTORY TAKING

•  An acquired skill

– requires practice

•  Assists in differential diagnosis

•  Information must be recorded

– a legal requirement

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PROBLEM SOLVING

•  Follow a routine

•  Consider the simple before the complex

•  Commence with high-probability causes

•  Rule out possible causes

– arrive at a differential diagnosis

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SYMPTOMS

•  Described by the patient (subjective)

•  Generally, a main symptom is reported

– this is the chief complaint

•  Usually have an organic or functional basis

•  Manifestation(s) of injury or disease

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SYMPTOMS

•  Real or imagined

•  Physical and/or physiological

•  Psychological basis?

•  May or may not be associated with signs

•  Type, time of onset, duration, course

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SIGNS

•  Detectable manifestations of injury or

disease

•  Seen by patient and/or practitioner

•  May or may not be associated with

symptoms

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DETECTION OF SIGNS

•  Requires skill and experience

•  Main observational tools are:

– illumination

– magnification

•  Specialized techniques may be required

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DETECTION OF SIGNS

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PRACTITIONER SKILL

Ability to: – investigate – deduce – analyse – diagnose – solve problems – educate

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PRACTITIONER SKILL

Employ SOAPE: – Subjective

– Objective

– Assessment

– Plan

– Education

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SYMPTOMS IN CONTACT LENS WEAR

•  Adaptive or normal symptoms

•  Abnormal symptoms

•  Dictate course of action

– monitor

– intervention

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CAUSE OF SYMPTOMS

•  Adaptive problems •  Procedural error by wearer •  Extraneous sources of irritation •  Psychological problems •  Physiological problems •  Lens fitting error •  Lens defect

Mandell, 1988

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SYMPTOMS WITH SIGNS

•  Easier to detect cause of problem(s)

•  Counseling of wearer often easier

•  Modify lens usage and/or wear mode

•  Wearer understands the need to change

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SYMPTOMS WITH SIGNS

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SYMPTOMS WITHOUT SIGNS

•  A thorough history is assumed

•  Are symptoms normal or abnormal?

•  Practitioner intervention is required

•  Wearer’s concerns need to be

allayed

•  Close monitoring required

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SYMPTOMS WITHOUT SIGNS

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SIGNS WITHOUT SYMPTOMS

•  Careful assessment requires: – observational skills

– routine follow-up

•  Extensive history taking

•  Prevention of problems

•  Careful patient education

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SIGNS WITHOUT SYMPTOMS

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CLINICAL INTERVENTION

•  Practitioner judgement

•  Need to counsel patient

•  Follow-up to confirm

expected improvement

•  Resolution of problem(s)

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CLINICAL INTERVENTION

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THANK YOU

Feedback on errors, omissions, or suggestions for improvement are invited. Please contact us at: [email protected]

See the following slides explaining the symbols, abbreviations,

and acronyms used in the IACLE Contact Lens Course

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SYMBOLS

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ABBREVIATIONS

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ACRONYMS

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ACRONYMS