chapter 28 Eyes
HISTORY
HISTORY OF PRESENTING ILLNESS
What is the main or most serious complaint?
MEDICAL HISTORY
Systemic diseases that affect adherence to topical treatment: arthritis, dementia, tremor, stroke.
OCULAR EXAMINATION FOR GENERAL PRACTITIONERS
STRUCTURED EXAMINATION
Visual acuity
Visual acuity near (NA)—ask the patient to read letters at 30 cm, with reading glasses if required.
Pupil examination
Relative afferent defect (RAPD)—there is paradoxical initial pupil dilatation in the illuminated eye when the torch is swung across from the other eye. With the patient fixating steadily at an object across the room, shine the light steadily for a few seconds into one eye, then swing it across to the second eye, watching the movement of that (second) pupil. If the first movement is constriction, the pupil response is normal; if the first movement is dilatation (and then constriction), that demonstrates a defect. Such a defect means that there is a relative abnormality in that optic nerve (compared with its fellow). It suggests optic neuropathy, such as optic neuritis or glaucoma (early to moderate loss is usually asymmetric).
Ocular examination
Always compare one side with the other, and use adequate illumination and magnification.
OCULAR CONDITIONS
PREVENTION
RED EYE
Red eye is very common and covers a broad spectrum of anterior segment diagnoses.
Conjunctivitis
Common
Bacterial conjunctivitis
(Staphylococcus epidermidis/aureus, Streptococcus pneumoniae, Haemophilus influenzae)
The conjunctiva appears ‘beefy red’ with yellow/green and mucopurulent discharge.