History Taking&
Examination of
Eye
BY/
MOHAMED AHMED EL –SHAFIE
ASSISTANT LECTURER IN OPHTHALMOLOGY DEPARTMENT
KAFRELSHIEKH UNIVERSITY
History
اسمع العيان
A good history commonly leads to a diagnosis
Helps you focus your examination
Indicates when/what investigations are needed
General Approach
Introduce yourself.
• Note – never forget patient names
•Respect patient privacy.
Try to see things from patient point of view. Understand
patient mental status, anxiety, irritation or depression.
Listening
Questioning: simple/clear/avoid medical terms/leading,
interrupting, direct questions and summarizing.
STRUCTURAL ORGANISATION OF
HISTORY
1. PERSONAL DATA
2. PRESENTING COMPLAINTS (P/C)
3. PAST OCULAR HISTORY (POHx)
4. PAST MEDICAL HISTORY (PMHx)
5. DRUG HISTORY (DHx)
6. FAMILY HISTORY (FHx)
7. SOCIAL HISTORY (SHx)
PERSONAL HISTORY
Name: To be familiar with your patient
Age:
Buphthalmos in infants
Keratoconus in teenage
Senile cataract in old age
Sex:
Males as Retinitis pigmentosa
Females as Autoimmune Diseases
Address: to know socioeconomic state
Telephone no: to keep contact with your patients
Special habits: Sports and smoking
Occupations: metal workers
COMPLAINTS
Patient Own Words
حتى لو بالعربى
Chief Complaint
• The main reason push the pt. to seek for visiting a ophthalmic
consultation.
• Usually a single symptoms, occasionally more than one complaints
e.g. blurred vision, swelling, pain, trauma, inflammation etc.
• The patient describe the problem in their own words.
• It should be recorded in his/her own words.
• What brings your here? How can I help you? What seems to be the
problem?
Analysis of complaints
How long?
Involving one or both eyes?
Any associated symptoms?
Any similar problems before?
COMPLAINTS
Visual :
*Diminution of vision:
Gradual: Cataract or errors of refraction
Sudden: CRAO
*Diplopia: uniocular or binocular
*Flashes of lights: RD
*Floaters as Musca volitans
*Metamorphopsia as in macular diseases
*Field defects: glaucoma
COMPLAINTS
Non Visual:
Eyelid Oedema
Redness
Lacrimation
Discharge
Itching
Burning
FB sensation
Pain
Phtophopia
PAST OCULAR HISTORY (POHx)
Any ocular medications, surgery, eye hospital
visits
Use of spectacles, contact lenses etc.
Last time spectacles where changed.
PAST MEDICAL HISTORY (PMHx)
DM
HTN
HIV
RHEUMATOID ATHRITIS
ASTHMA
CARDIAC DISEASE
DRUG HISTORY (DHx)
BETA BLOCKERS
ANTI COAGULANTS
STEROIDS – in steroid responders, causes
glaucoma
TOPICAL GENTAMYCIN – causes epithelial
toxicity
FAMILY HISTORY (FHx)
Myopia,
Squint,
Glaucoma
Eye cancer
Retinitis Pigmentosa
SOCIAL HISTORY
Smoking
Alcohol
Occupation
Home circumstances
EXAMINATION
OD (oculus dexter) right eye. RE
OS (oculus sinister) left eye. LE
OU (oculus uterque) both eyes
BE
EXAMINATION
Visual Acuity
(VA)
NORMAL VISUAL RESPONSE
Age Visual response
Newborn Light perception
4-7 weeks Eye contact with mother
4-12 weeks Fixates and follows interesting bright
coloured objects
3 months Change expression smiles and cries
3-4 months Reach objects using vision
6-9 months Crawling and later walking avoiding
objects
Gwiazda et al 1980
FIXATION TARGETS (fix and follow) :
If appropriate targets are used, this reflex can be demonstrated
by about 6 wk of age.
Binocular fixation preference :
OPTICOKINETIC NYSTAGMUS :
Evaluation of the presence or absence of
opticokinetic nystagmus was the first “technologic”
approach to acuity measurement in preverbal
children.
VISUAL ACUITY
Rules
It is a test for central vision only
Discuss gratings with your patient
Start with one eye (uniocular)
Good illuminated chart with higher contrast
VISUAL ACUITY
Pin Hole test
To differentiate refractive errors
from organic diseases by
blocking peripheral rayes
VEDIO
VISUAL ACUITY
Interpretation
UCVA
BCVA
6/6
20/20
1.00
EXAMINATION
1. ADNEXA
2. ANTERIOR SEGMENT
3. POSTERIORS SEGMENT
SLIT LAMP
BIOMICROSCOPE
ADNEXA
ORBITAL RIM
EYE BROW
EYE LIDS:Ptosis
Lid retraction
EYE LASHES
ORIFICES
ANTERIOR SEGMENT
CONJUNCTIVA
CORNEA
A/C
PUPIL
IRIS
LENS
Examination of IRIS
COLOUR
Light blue or green in Caucasians and Dark brown in
orientals
Heterochromia iridium- different colour
of 2 iris
Heterochromia iridis-different colour of sectors of the
same iris
Examination of PUPIL
NUMBER
o Normal: 1 pupil
o Rarely: more than 1 pupil (polycoria)
LOCATION
o Normal: almost centre of the iris, slightly nasal
o Rarely: congenitally eccentric (corectopia)
SIZE
o Normal: 3-4mm depending upon illumination
o It may be abnormally small (miosis) or large(mydriasis)
o Anisocoria- It is a condition where there is difference
between the size of two pupils
Examination of LENS
POSITION
o Normal: patellar fossa by the zonules
o Dislocation of lens: lens not present in its normal position
i. Anterior dislocation-present in anterior chamber
ii. Posterior dislocation-present in vitreous cavity
o Subluxation of lens-lens is partially displaced from its position
• Causes-trauma, marfan’s syndrome, homocystinuria
o Aphakia-absence of lens
• It is diagnosed by
i. jet black pupil, deep anterior chamber, empty patellar fossa by slit
lamp biomicroscopy
ii. hypermetropic eye on ophthalmoscopy, retinoscopy
iii. ABSENCE of 3rd and 4th purkinje images
o Pseudophakia-
• When posterior chamber IOL is present, it is diagnosed by black
pupil, deep anterior chamber, shining reflexes (from anterior surface of
IOL) and PRESENCE of all the four Purkinje images
POSTERIOR SEGMENT
VITREOUS: Haziness, cells, h’age
OPTIC NERVE: CDR, pale, blurred
margin
VESSELS: aneurysm, Ghost vessels
MACUALR: normal, dull reflex, h’age.
hole
Techniques of Fundus Examination
1) Ophthalmoscopy
a) Distant direct ophthalmoscopy
b) Direct ophthalmoscopy
c) Indirect ophthalmoscopy
2) Slit lamp bio-microscopic examination by
a) Indirect slit lamp bio-microscopy
b) Hruby lens bio-microscopy
c) Contact lens bio-microscopy
THANK YOU
