Symptoms
Redness
Pain
Blurred vision
Watering
Sign
Reduced VA
Epithelial abrasion
Swollen optic disc
Raised IOP
Management
Advice
Artificial tears
Antibacterial tears
Referrals
Reason for visit
Patients may come into practice with a specific symptom (chief complaint) or for a routine check.
Key symptoms/ questions
Reduced vision
Headaches
Diplopia
Flashing lights
Floaters
Exploring the chief complaint
Location
Onset
Frequency
Time
Self treatment
Association
Reduced vision
- Is it monocular or binocular
- Is the vision reduced at near, distance or both
- Determine if its constant or intermitten
- Inquire about severity and potential cause such as ocular disease or refractive error ]
- Consider accommodation annomalies like amblyopia
Diplopia
- Is it genuine diplopia or does the patient see blurred images, ask if they see 2 distinict images
- Is it monocular or binocular diplopia
- Monocular diplopia could be caused by a cataract particularly cortical cataract
- Binocular diplopia often indicates misalignment or can be due to neurological issue or weakness of the eye muscles
- Determine weather it is vertical or horizontal diplopia is the image side by side or on top of the other
Flashing lights
- Distinguish between visual phenomena and flashing lights
- Flashing light that caused by to retinal or vitreous detachment occurs when the vitreous gel tugs on the retina
- Ask the px weather it is monocular or binocular, duration and weather it is worse under specific light conditions
- Flashed caused by detachment are usually brief and effect the temporal visual field
Floaters
- Floaters are common and are caused by change in the vitreous humour structure
- Patients may describe floaters as spots, cobwebs, or threads that move with the eye motion
- Ask patient about the frequency, apperance and mono/ bono about floaters
- Sudden onset of floaters indicate retinal or vitreous detachment
Red eye
- Determine if the redness if unilateral or bilateral and ask px if the redness started simultaneously in both eyes
- Consider the level of comfort, pain, photophobia that can indicate underlying causes of redness
- Observe the eye for any sticky discharge which can indicate bacterial conjunctivitis, watery discharge indicates viral infection or ocular allergy
Beyond symptoms
General history - Diabetes and high blood pressure
- Medication
-Allergies
Family history - Diabetes or high blood pressure
Ocular history- ever visited the hospital as a kid or worse an eye patch
Family ocular history- any problems with eyes, galucoma
Lifestyle- what do you do for a living
Headaches
- Exclude any visual or ocular explanation
- Distinguish between longstanding an those that are new (always had headache)
- Do they go away with pain killers
- Can be caused by intracranial pressure (pressure around the eyes
