eye cases: how?
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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eye cases: how?
DR. PRANAV BHAGWATDR. JIJITH C.R.
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HISTORY TAKING
– Allow patient to tell story.
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Decreased vision
Ask for
• Onset
• Duration
• Uni / Bilateral
• Distant or near vision
• Whether the patient wears glasses
• Diurnal variation
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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
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Sudden bilateral loss of vision
• Acute methanol toxicity
• Hysteria
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Reduced vision in the morning, improved in afternoon
• Intermittent corneal edema
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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
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Pain in the eye
• Type
• Onset
• Duration
• Diurnal variation
• Associated complaints e.g., nausea, vomiting, DV
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Severe eye pain
• Adhimantha
• K abrasions and ulcers
• Acute iridocyclitis
• Panopthalmitis
• Acute glaucoma
• Scleritis
• Episcleritis
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Dull Aching pain
• Cases with eye strain
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Mild eye pain
• Corneal FB
• Conjunctival FB
• Conjunctivitis
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Pain around the eye
• Pathology of the lid and lacrimal apparatus (eg: stye)
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Redness of the eye
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Normal eye lid with normal corrected visual acuity
• Conjunctivitis
• Keratitis
• Corneal ulcer
• Arjuna
• Episcleritis
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Abnormal eye lid with normal corrected visual acuity
• Ectropion
• Entropion
• Stye
• Blepharitis
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Reduced corrected visual acuity without diplopia
• Iritis
• ACG
• K foreign body
• K ulcer
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Reduced corrected visual acuity with diplopia
• Carvernos sinus thrombosis
• Orbital cellulitis
• Caratico carvernos fistula
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Common causes –red eye.
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Photophobia
• Acute infective or inflammatory lesion of the anterior segment
• Recently operated eyes
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Watering of the eyes
1)Excessive lacrimation• Keratitis• Uveitis• Glaucoma
2) Epiphora• Mechanical obstruction to drainage- stricture,
punctal stenosis & chronic dacryocistitis• Defective orbicularis action
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Discharge
• Watery-Mild bacterial infection
• Serous -viral
• Mucoid -mild conjunctivitis
• Mucopurulent & purulent- acute pyogenic infection of anterior segment
• Serosanguinous- opthalmia neonatrum
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Itching
• Allergic disoders- phlycten
• Episcleritis
• Spring catarrh
• Allergic blepharo conjunctivitis
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Netra daaha
• Pittotklishta
• Pittaja abhishyanda
• Pitta vidagdha drishti.
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Foreign body sensation
• Presence of FB
• Distorted eye lashes- trichiasis, entropion
• Conjunctival concretion, calcification
• Contact lenses
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Black spots in front of eyes
• 1) Stationary
K scars, lens opacity
• 2) Mobile- Vitreous opacities
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Headache
• Refractive errors
• Improperly corrected refractive errors
• Zoster
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Haloes around light
• 1) Early ACG
• 2) Acute mucopurulent conjunctivitis
• 3) Early stages of cataract
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Photopsiae
• Irritative lesions of retina
• Impending RD
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Diplopia
• 1) Unioccular- high K astigmatism, subluxated or dislocated lens
• 2) Binocular- Squint
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Nyctalopia
• Vitamin A deficiency
• Retinitis pigmentosa
• Pathological myopia
• Glaucoma
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Occupation
• Welders
• Black smiths- foreign body in the eye
• Farmers- fungal keratitis
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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
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Past history
• Systemic diseases- diabetis mellitus
• Arjuna-HT
• Iritis- ankylosing spondylitis
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History of previous ocular disease
• Childhood squint- lazy eye
• Blunt injury- traumatic mydriasis ( could be confused with partial third nerve palsy)
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Family history
• Chronic glaucoma- the incidence nearly 5 times greater in siblings and children of affected patients
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Examination of the function of eye
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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
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• Jaeger’s test type
• N5 to N48
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Visual field
• 1) Peripheral field- confrontation or perimeter
• 2) Central field by scotometery
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Colour vision
• Ishiahara chart
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Ocular and periocular examination
• 1) Head posture-
Paralytic squint.
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Face
• Look for
• Asymmetry
• Signs of paralysis
• Obvious skin changes
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Orbit
• Inspection and palpation
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Eye brows
• Look for loss of hair- lepromatous leprosy, myxoedema
• Depigmentation
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Eye lid
• 1) Position of the lid margin in relation to cornea- drooping of lids
• 2) Thickness of the lid• 3) Swelling
a) Localised eg) Stye, chalazion
b) Generalised- Oedema,ecchymosis
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Pakshma mandal
• Trichiasis- misdirection of lashes
• Distichiasis- double row
• Madarosis- scantiness
• Matting- conjunctivitis
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Shuklamandal (conjunctiva & sclera)
• 1) Bulbar conjunctiva
a) congestion- ciliary/conjunctival
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b) Chemosis-
c) Subconjunctival haemorrhage
d) Pigmentation
e) Nodule
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Upper tarsal conjunctiva
• Congestion
• Alteration of normal vertical vascular pattern
• Follicle/papilla
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• Scarring
• Membrane formation
• Granuloma
• Foreign body
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Lower tarsal conjunctiva
• As above + any sign of symblepheron
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Staining
• 2% fluorescein- raw area- green
• 1% rose bengal- conjunctiva- pinkish red
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Sclera
• Colour change • Pigmentation• Protrusion of uveal
tissue• Congestion
• Nodule formation
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Krishnamndal (cornea & iris)
• Cornea
• 1) Size- normal (12 to 13 mm)
• 2) Curvature-conical / globular / flat
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• Surface- examine by window reflex / placido disc / slit lamp
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• Irregular surface- corneal ulcer, scarring
• Depression / corneal facets
• Elevation- epithelial bulla
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• Opacity
• 1) density- nebula / macula / leucoma
• 2) Situation and extent in relation to pupil
• 3) Iris adhesion
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• Pannus (sirashuklam)-
• Keratic precipitates
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• Corneal sensationsDiminished sensation- • Herpes• 5th nerve paralysis• ACG and absolute glaucoma• Leprosy• Prolonged use of contact lens• Post surgery• Local anaesthesia
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• Corneal stains
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Iris
• 1) Iris pattern
• 2) Colour
• 3) Vessels- visible = patho.
• 4) Atropic patches = end stage of glaucoma
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Defect in the iris
• Iridodonesis- aphakia / buphthalmos
• Iridodyalisis
• Anterior synechia
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• Anterior chamber
Depth and content
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Pupil
• Size- (3 to 4mm)
• Shape
• Position
• Pupillary margin
• Pupillary aperture
• Pupil reaction
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Lens
• Colour
• Opacity
• Position
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Pakshmavarthmagathasanthi
• Entropion
• Ectropion
• Tylosis
• Milphosis
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Kaneenika sandhi
• Lacrimal puncta- eversion / stenosis / absence
• Skin around it
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Shuklakrishnagatha santhi
• Nodule• Congestion
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Tonometrytonopen Shiotz tonometer.
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Fundoscopy
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Ocular coherence tomography
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• Thank you!