docSigns of Eye Disease
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Signs of Eye Disease
Signs of Eye Disease Associate Professor Dipika Patel Department of Ophthalmology Major issue with triage • Is this serious? • Is this non-urgent? • Does it need referred? • Can I deal with it myself? Is this serious? Is this serious? Need a system! Examination • Step back: look at overall patient – Is this a sick patient? • Step back: look at face – Is this an eye problem, or skin problem? Examination • Visual acuity • Lids and anterior segment • Fluorescein • Intraocular pressure • Colour vision • Visual fields • Eye movements • Pupil reactions • Fundus Visual acuity Visual acuity Distance patient read chart Line read 6/60 6/18 6/6 6/4 Visual Acuity Options Visual Acuity Lids • • • • Able to open? Position Colour Tender? Remember the brain! Fluorescein • • • • Stains epithelial defects Assessing tear film Detecting leaks Checking intraocular pressure Every red eye needs dye… Conjunctiva • • Colour? Distribution? Cornea • • • • Colour: Clear/Opaque Staining Foreign body? SubTarsal Anterior Chamber • • • • Deep/normal? Shallow/collapsed? Blood – hyphaema Pus/White cells hypopyon Intraocular pressure Goldman tonometry IOP Assessment Colour vision Visual fields • Test on confrontation Visual field defects Normal field Visual field defects Hemianopia Visual field defects Quadrantanopia Visual field defects Central scotoma Visual field defects Tunnel vision Eye movements Eye movements Pupil reactions • Responses to light • Direct • Consensual • RAPD • Response to accommodation Tools of the trade Fundus examination • Must dilate pupils • Tropicamide eye drops Red reflex Present / reduced? Fundus examination • Don’t be shy! • Remember to breathe! Fundus examination • • • • • Monocular Erect image (upright) High magnification (x 15) Restricted field of view (7 - 8°) Provides view to the arcades Don’t forget the brain! Summary • Don’t panic: take your time • Measure visual acuity • Check pupils • Work through structures (front to back) • Every red eye needs dye (fluorescein) • Think: emergency/urgent/soon/routine THANKS
