signs of eye disease - auckland€¦ · visual field defects . tunnel vision . visual field defects...
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Signs of Eye Disease
Associate Professor Dipika Patel Department of Ophthalmology
Major issue with triage
• Is this serious? • Is this non-urgent? • Does it need referred? • Can I deal with it myself?
Is this serious?
Is this serious?
Need a system!
Examination
• Step back: look at overall patient – Is this a sick patient?
• Step back: look at face
– Is this an eye problem, or skin problem?
Examination • Visual acuity
• Lids and anterior segment
• Fluorescein
• Intraocular pressure
• Colour vision
• Visual fields
• Eye movements
• Pupil reactions
• Fundus
Visual acuity
Visual acuity
Distance patient read chart
Line read
6/60 6/18 6/6 6/4
Visual Acuity Options
Visual Acuity
Lids • Able to open? • Position • Colour • Tender?
Remember the brain!
Fluorescein
• Stains epithelial defects
• Assessing tear film
• Detecting leaks
• Checking intraocular pressure
Every red eye needs dye…
Conjunctiva
• Colour? • Distribution?
Cornea • Colour: Clear/Opaque • Staining • Foreign body? • SubTarsal
Anterior Chamber • Deep/normal? • Shallow/collapsed? • Blood – hyphaema • Pus/White cells -
hypopyon
Intraocular pressure
Goldman tonometry
IOP Assessment
Visual fields
• Test on confrontation
Normal field
Visual field defects
Hemianopia
Visual field defects
Quadrantanopia
Visual field defects
Central scotoma
Visual field defects
Tunnel vision
Visual field defects
Eye movements
Eye movements
Pupil reactions
• Responses to light • Direct • Consensual
• RAPD
• Response to accommodation
Tools of the trade
Fundus examination
• Must dilate pupils
• Tropicamide eye drops
Red reflex
Present / reduced?
Fundus examination
•Don’t be shy! •Remember to
breathe!
Fundus examination
• Monocular
• Erect image (upright)
• High magnification (x 15)
• Restricted field of view (7 - 8°)
• Provides view to the arcades
Don’t forget the brain!
Summary
• Don’t panic: take your time • Measure visual acuity • Check pupils • Work through structures (front to back) • Every red eye needs dye (fluorescein) • Think: emergency/urgent/soon/routine