how to examine the eye in family practice - gp cme north/fri_room3_1400_welch gp... ·...
TRANSCRIPT
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How to Examine the Eye in Family Practice
Sarah Welch
GP CME 2014
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Introduction
• Equipment and drops
• History
• Examination
• Management
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Equipment
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Drops
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Tools for Management
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History
• Change in Vision
• Ocular Discomfort
• Change in Ocular Appearance
• Trauma
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Change in Vision
• Timing– Gradual– Sudden– Fluctuating
• Time of day – morning/ evening/ dark/light
• Disturbance– Central loss– Distortion– Field loss– Flashes/floaters– Haloes
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Ocular Discomfort
• Aching
• Burning
• Foreign Body sensation
• Glare
• Headache
• Pain on eye movements
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Uveitis
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Uveitis
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Acute Angle Closure Glaucoma
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Change in Ocular Appearance
• Red Eye
• Lid malposition
• Shrinking Eye
• Swollen Lids
• Unequal pupils
• Prominent Eye
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Red Eye
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Red Eye
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Ectropion
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Ptosis
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Chalazion
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Enophthalmos
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Proptosis
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Examination
• Vision
• Anterior Segment
• Posterior Segment
• Pupils and Red Reflex
• Eye Movements
• Visual Fields
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Visual Acuity
• Well lit chart
• With Glasses on
• Use occluder
• Use a pin hole
• Standardised Distance
• Charts are available on line – Near, colour, snellen
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Visual Acuity Terminology
• NPL
• LP
• HM
• CF
• 6/60 – 6/6
• ph, gl
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Corneal abrasion
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Corneal Foreign Body
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• Subconjunctival haemorrhage
– maybe slightly gritty/dry feeling
• Treatment:
– Lubricants
Painless Red Eye
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Subconjunctival Haemorrhage
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Large Subconjunctival Haemorrhage
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Pingueculum
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Pterygium
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• Scratchy/Gritty
• Aching
• Deep headache, nausea, vomiting
Painful Red Eye
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• Chronic symptoms
• Often have blurring of vision with reading
• Worse in wind / air conditioning / cold
• Treatment– Lots of lubricants
– Blepharitis lid care
• Manage not cure
Dry Eye/Blepharitis
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Blepharitis
• Scales around base of lashes (collarettes)
• Chronic irritation worse in mornings
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Blepharitis
• Shiny anterior lid margin • Greasy scales
• Lashes stuck together• Hyperaemia of lid margin
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Posterior Segment
• Symptoms
– Flashes
– Floaters
– Change in Vision
• Red Reflex
• Vision
• Projection/fields
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Amsler Grid
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Pupils
• Response to light
• RAPD
• Red Reflex
• Symmetrical
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RAPD – Relative Afferent Pupillary Defect
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Eye Movements
• Squints
• Loss of Eye Movement
– Nerve palsies
– Restriction
• Nystagmus
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• Force of Injury
• Hammering Metal on Metal
• Grinding
• Abrasion
Trauma
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Complications of blunt trauma
Sphincter tear
Cataract Angle recession
Hyphaema
Lens subluxation
Iridodialysis Vossius ring
Rupture of globe
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Complications of penetrating trauma
Flat anterior chamber
Vitreous haemorrhage
Damage to lens and iris
EndophthalmitisTractional retinal detachment
Uveal prolapse
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Management of intraocular foreign bodies
Removal by pars plana vitrectomy
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THANK YOU