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