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HISTORY TAKING SKILLS ---1.pptx
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- 2. DEFINED DATA BASE •Patient profile • Chief complaint • Present illness • Review of systems • Physical examination • Laboratory reports
- 3. DEMOGRAPHIC INFORMATION • Name. General allergy • Age . Occupational & Visual requirements • Sex • Marital status • Address • Telephone number • E-mail ID • Occupation • Previous drug allergy
- 4. OCULAR HISTORY • EXISTINGSPECTACLE WEARER: • PGP noted down • How old • Last refraction done • Type of lens • Any tints present • Bifocals/single vision/multifocals • Prisms induced • EXISTING CONTACT LENS WEARERS: • How old • How many hours/day • Type of lens • Material/power/diameter • In case of RGP optic zone base curve/diameter/ central thickness •Any eye injuries, previous diseases of the eye, any surgeries, had undergone any treatment, etc.,
- 7. MNEMONICS – THECHIEF COMPLAINT B : Blurred vision E : Eye strain D : Disturbances in vision H : Headache E : External eye symptoms D : Deviating eye P : Protrusion of eye U : Unequal pupil size R : Reading/learning problems
- 12. Remember! • Avoid leadingquestions. • You don’t smoke do you? • You haven’t had any eye pain earlier? • You haven’t visited any other doctor? • Avoid compound questions. • Do you have trouble sleeping? • How much sleep do you get? • Do you use cocaine/marijuana, alcohol etc.,?
- 13. BLURRED VISION LOCATION AGEDEFECT For distance Children Myopia For near In middle aged adult Presbyopia After prolonged close work In non presbyopic age Hyperopia In reduced illumination Young/old Night myopia/RP In bright light/daylight Young/old Intermittent squint/NS/PSC Transient loss of vision In elderly adult Temporal arteritis/carotid artery occlusive disease/migraine/multipl e sclerosis
- 14. • Blurred visionis unilateral – Amblyopia – cause to be found whether strabismic/anisometropic/ or high astigmatism. • Blurred vision in an adult – if accompanies change in refraction – more myopia/less hyperopia – NS or blood sugar levels increased. • Usually unilateral – NS & bilateral – increase in blood sugar levels. • No change in refraction – lens opacities/ARMD • Blurred vision with decreased visual acuity – no change in refraction – requires additional testing – retinal, optic nerve/lenticular problems.
- 15. EYE STRAIN/ASTHENOPIA • Feelingof fatigue • Discomfort or pain localized in or around the eyes and thought to be associated with the use of eyes. • Pulling sensation • Poor concentration • Strain around the eyebrow • Often confused with headache
- 16. • Myopia: C/Oeyestrain or visual fatigue is not common. • Hyperopia: excessive use of accommodation leads to asthenopia • Astigmatism: Hyperopic astigmatism: one or both focal lines fall behind the retina. Hence the circle of least confusionis on or near the retina, thereby improving the visual acuity, but causes asthenopia. • Myopic astigmatism: will not improve with accommodation and hence no asthenopia.
- 17. BINOCULAR ANOMALIES Convergence ConvergenceDivergence Divergence Excess Insufficiency Excess Insufficiency for near for distance AC/A ratio › AC/A ratio ‹ AC//A ratio› AC/A ratio Near than distance distance ‹ distance Distance than near than near than near
- 18. • Anisometropia: uncorrectedanisometropia, even of moderate amount can cause eyestrain due to difficulty in maintaining clear images on both retina at the same time. • Anisokonia: a difference in the size and shape of the retinal images for the two eyes is usually the result of magnification differences brought about by corrective lenses & this causes eyestrain & headache. • • Strabismus: manifest or latent. Eyestrain more common in latent than in manifest. Functional or paralytic. Functional- eyestrain more common than in paralytic. Paralytic usually asthenopia is in later stage.
- 19. DISTURBANCES IN VISION •To: Temporary loss of vision • Day: Distortion in size & shapes of objects • Faint: Flashes & floaters • Drizzle with: Diplopia • Hot &: Halos • Cold: Curtain coming down • Showers: Spots
- 20. Temporary loss ofvision • Migraine • Multiple sclerosis (MS) • Carotid artery occlusive disease (CAOD) • Temporal arteritis (TA) • Migraine: visual aura, sick headache, heat waves & light flashes, temporary loss of vision. DD: through history • Multiple sclerosis: temporary loss of vision due to retrobulbar neuritis are early symptoms, positive scotoma, scotoma is ameboid in nature and patient can plot it.
- 21. • Migraine &MS usually young and middle aged. • CAOD & TA most commonly beyond 55 or 60yrs. • CAOD: due to deposition of atheromatous plaques within the internal carotid arteries. Most common ocular symptom is Amaurosis Fugax – a sudden transient painless loss of vision. Vision loss is due to migration of emboli consisting of platelets, fibrin, and cholesterol into the retinal arterial tree. Patient during an attack sees both yellow or white emboli. White emboli – platelets & fibrin Yellow emboli – cholesterol – Hollenhorst plaques
- 22. • TA: Giantcell arteritis and cranial arteritis. Inflammation of the temporal branch of the internal carotid artery which supplies central artery of the retina. Headache in the temporal region General feeling of malaise Loss of appetite, scalp tenderness Claudication of the jaw while chewing.
- 23. Distortion of objects •Distortion in size can be perceptual or optical. • Occasionally patient’s perception of environmental visual clues to size breaks down. • They may be alarmed that the faces and things appear larger/smaller than they think it should be. • Optical can be due to newly prescribed +/- lenses and accommodative micropsia is minification of retinal image due to excessive accommodation. • Macular problems – metamorphopsia.
- 24. Flashes & floaters •Muscae valitantes: vitreous becomes partially liquified mostly in myopes and older people. Vitreous opacities cast shadows on the retina. Commonly seen when looking at the sky or some unstructured background. Patient describes them as spots, stings, cobwebs, or rings etc., They move across the visual field when eye movement is made. They move faster than the eye movement.
- 25. • Pars planaitis:chronic anterior uveitis. Usually due to presence of cells in the retro- lental space/anterior vitreous. This remains stationary and gradually increases over a period of time. Common complications are PSC and cystoid macular oedema. • Retinal heamorrhages: c/o red spots Due to retinal heamorrhages in the vitreous. DR, HR, etc.,
- 26. Flashes: Muscae valiantes Pars planitis Retinalheamorrhages PVD (arc of flash) Migraine Lesions of visual cortex
- 27. Diplopia Monocular Binocular • Keratoconus. Binocular vision • Corneal edema anomalies, • Refractive errors • Cataract . Recent onset acquired muscle palsy, . Cerebral vascular accident
- 28. Halos • Rainbow colorsaround the light. • Usually in angle closure glaucoma, due to corneal edema. • Can be due to tiny hillocks in corneal epithelium.
- 29. • How todifferentiate between glaucomatous halo & that due to radical structure of crystalline lens? • If a vertically oriented stenopic slit is moved back and forth, horizontally in front of the pupil, • a halo caused by radical structure of the lens will appear to rotate with a wheel like motion. • a halo due to corneal edema – the halo will not rotate.
- 30. Curtain in frontof the eyes • Classic symptom of a retinal detachment. • It appears like a curtain is falling in front of the eye. • Its an emergency. Spots • Same as that of floaters
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- 33. • Which partof the head does it hurt – forehead/sides/back of the head etc.,
- 39. NON-OCULAR MNEMONICS • My- Migraine • Mother - Muscular contractions • Cook - Cluster • Nice - Nasal sinusitis • Hot - Hypertensive • Tasty - Temporal arteritis • Tiffins - Trigeminal neuralgia
- 40. MIGRAINE • Prodrmal visualaura • Unilateral, throbbing headache with nausea • Scintillating scotoma • Constriction of the internal carotid artery supplying visual cortex • First dilation & then congestion of the arteries • Treatment both prophylactic and symptomatic medication.
- 41. MUSCULAR CONTRACTION • Vicelike pain in the forehead, or pain in the cortex. • Also known as tension headache. • Pain in the occipital area along with muscular stiffness in the neck. • Mainly due to stress & psychological • Treatment is with analgesics, muscle relaxants and sedatives.
- 42. CLUSTER • Also knownas Histamine Cephalgia • Severe boring headache, unilateral occuring in the temporal region accompanied by ipsilateral lacrimation & nasal congestion. • Cluster because one or more headaches occur daily within a short period of time. • Typically occurs at night mainly when the person is lying down. • Treatment similar to that of migraine.
- 43. NASAL SINUSITIS • Mostpredominant in acute nasal sinusitis than in chronic nasal sinusitis. • Pain in the frontal region & increases on stooping down. • Other symptoms associated are coughing due to postnasal drip, low grade fever & temporary loss of the sense of smell.
- 44. HYPERTENSIVE • Severe occuringearly in the morning on awakening and disappearing during the course of the day. • Reduces on taking a cup of black coffee immediately on arising. • Early treatment of hypertension reduces the risks.
- 45. TRIGEMINAL NEURALGIA • Extremelysharp, piercing, knife like pain of sudden onset in the facial region. • Can be due to inflammation of any three divisions – least common is ophthalmic division. • Trigger zone – pain cab be brought by touching a specific area while washing the face, cleaning the teeth or shaving, etc., • Usually middle aged or elderly. • State of constant fear. • Usually not confused with other types of headaches, as this presents in the areas distributed by the maxillary & mandibular. • Treatment is anti-convulsives .
- 46. EXTERNAL EYE SYMPTOMS •Itching & burning sensation of the eyes • Pain & foreign body sensation • Sensitivity to light • Excessive tearing • Feeling of dryness. • Mostly manifestations of asthenopia- uncorrected refractive errors or binocular vision problems
- 47. ITCHING & BURNINGSENSATION • Asthenopia causing this is due to triggering the local axon reflex. • Effort to compensate for the refractive error stimulates nerve ending, there by leading to increased blood supply to the localised area. • This leads to hyperemia & itching. • Due to rubbing, increase in bacterial content of the tears & this leads to inflammation. • Hence this leads to recurrent styes in small refractive errors. BLEPHERITIS ALLERGIC CONJUNCTIVITIS VIRAL CONJUNCTIVITIS BACTERIAL CONJUNCTIVITIS
- 48. Pain & foreignbody sensation Superficial Deep seated • Foreign body either in the . Corneal ulcers conjunctiva or corneal or acute Iritis or epithelium. acute Glaucoma • Visual acuity not affected . Visual acuity • Treatment by removal . Presence of A/C cells & flare
- 49. SENSITIVITY TO LIGHT PainPhotophobia Lacrimation • Conditions with predominant photophobia are: a) epidemic kerato- b) congenital conjunctivitis glaucoma Follicular conjunctivitis . Extreme photophobia Pain & tearing . Excessive tearing in After 7 days raised epi-lesions the first few months Stains with fluroscein of the life. Scattered over cornea . Suspect glaucoma Marked photophobia . Noticeable enlarge- After 7 days sunepithelial opacities ment in the size of the eye. (buphthalmos)
- 50. EXCESSIVE TEARING • Stenosisof the lacrimal duct • Ectropion FEELING OF DRYNESS • Aqueous deficiency • Mucin deficiency • Lid surfacing abnormalities DEVIATING EYE • Pseudo strabismus • True deviations: a) phoria, b) tropia.
- 51. PROTRUDING EYE • Congenitalor infantile glaucoma • Microphthalmos of the other eye • Exophthalmos due to mass affecting the orbit or optic nerve.
- 52. Vision Related LearningProblems • Physical Symptoms • Jerky eye movements, one eye turning in or out • Squinting, eye rubbing, or excessive blinking • Blurred or double vision • Headaches, dizziness, or nausea after reading • Head tilting, closing or blocking one eye when reading
- 53. Vision Related LearningProblems • Secondary Symptoms • Smart in everything but school • Low self-esteem, poor self image • Temper flare ups, aggressiveness • Frequent crying • Short attention span • Fatigue, frustration, stress • Irritability • Day dreaming
- 54. Vision Related LearningProblems • Performance Clues • Avoidance of near work • Frequent loss of place • Omits, inserts, or rereads letters/words • Confuses similar looking words • Failure to recognize the same word in the next sentence • Poor reading comprehension • Difficulty copying from the chalkboard • Book held too close to the eyes • Inconsistent or poor sports performance
- 55. Vision Related LearningProblems • Social Labels • Lazy • Dyslexic • Attention Deficit Disorder • Slow learner • Behavioral problems • Working below potential