History taking in History taking in ophthalmologyophthalmology

HistoryHistory A good history commonly leads to A good history commonly leads to

a diagnosisa diagnosis Helps you focus your examinationHelps you focus your examination Indicates when/what Indicates when/what

investigations are neededinvestigations are needed Helps determine the functional Helps determine the functional

impact of the conditionimpact of the condition

HistoryHistory Record age and genderRecord age and gender Presenting complaintPresenting complaint History of presenting complaintHistory of presenting complaint Past ophthalmic historyPast ophthalmic history Past medical historyPast medical history MedicationsMedications Family historyFamily history AllergiesAllergies Social historySocial history

HistoryHistory

Presenting complaintPresenting complaint

History of presenting complaintHistory of presenting complaint How long?How long? Involving one or both eyes?Involving one or both eyes? Any associated symptoms?Any associated symptoms? Any similar problems before?Any similar problems before?

Presenting complaintsPresenting complaints

Visual disturbance Visual disturbance PainPain Red eyeRed eye DischargeDischarge Itchy/dry/gritty eyesItchy/dry/gritty eyes Alteration in appearanceAlteration in appearance

Ptosis, lid swelling, squintPtosis, lid swelling, squint

Past ocular historyPast ocular history

Previous eye problemsPrevious eye problems Refractive errors (myopia, Refractive errors (myopia,

hyperopia, astigmatism)hyperopia, astigmatism) Ocular surgeryOcular surgery Ocular traumaOcular trauma SquintSquint Lazy eyeLazy eye

Past medical historyPast medical history

Diabetes?Diabetes? Hypertension?Hypertension? Rheumatoid arthritis?Rheumatoid arthritis? Sarcoidosis?Sarcoidosis? Asthma?Asthma? Eczema or other skin problems?Eczema or other skin problems? Other Other

MedicationsMedications

Present and pastPresent and past

AllergiesAllergies

AntibioticsAntibiotics Hay feverHay fever Any other medicationAny other medication

Family historyFamily history

SquintSquint GlaucomaGlaucoma MyopiaMyopia CataractsCataracts Poor vision etc.Poor vision etc.

Birth historyBirth history

For children onlyFor children only PrematurityPrematurity Forceps deliveryForceps delivery Low birth weightLow birth weight

Social historySocial history

SmokingSmoking AlcoholAlcohol OccupationOccupation Home circumstancesHome circumstances

Central retinal artery occlusion, note- pale posterior pole (fromischaemia and retinal oedema) red macula (due to choroidal circulation visable through thinnest part of the retina at macula )

Central retinal vein occlusion

Proliferative diabetic retinopathy

Inferior retinal Inferior retinal detachmentdetachment

Retinitis pigmentosa Leads to lossof peripheralvision and night blindnessNote pale disc, attenuated vessels and pigmentary changes in the periphery.

Pan retinal photocoagulation for diabetic retinopathy

Swollen disc from ischaemic optic neuropathy

Neovascular age related macular degeneration

Acute angle closure glaucoma

Acute angle closure glaucomaAcute angle closure glaucomaNote red conjunctiva, hazy cornea due to corneal oedema, Note red conjunctiva, hazy cornea due to corneal oedema, dilated pupil. dilated pupil.

This patient will have a very hard eye.This patient will have a very hard eye.

Dendritic ulcerDendritic ulcer

Note branching pattern of stainjng with Note branching pattern of stainjng with fluorescein under blue ultra violet lightfluorescein under blue ultra violet light

PtosisPtosis

ExophthalmosExophthalmosNote – lid retraction on rightNote – lid retraction on right

also bilateral cataracts also bilateral cataracts as greyish colour in pupils as greyish colour in pupils and bilateral arcus senilis and bilateral arcus senilis (white rings around margins of (white rings around margins of both corneas)both corneas)

Corneal ulcer and hypopion