Eye HX

Eye problem Hx
Common presenting complaints:

1. Disturbance of vision/Altered vision
o Did the change in vision start suddenly or gradually?
o Is pain associated with the change in vision?
- Sudden, painless loss of vision  retinal vascular occlusion or a retinal detachment.
- Sudden, painful loss of vision  attacks of acute narrow-angle glaucoma.
- Gradual, painless loss of vision  chronic simple glaucoma and cataracts.
o How is the vision affected (loss of vision, cloudy vision, floaters, distortion)?
- Flashes and floaters  disturbance of the vitreous and the retina (most commonly in posterior vitreous detachment), usually found in older patients.
- Distorted vision  disruption to the normal structure of the macula.
- Haloes are colored lights seen around bright lights  angle-closure glaucoma.
o Is it one or both eyes that are affected?
o Is the whole or only part of the visual field affected?
o If partial, which part of the visual field is affected?
2. Pain (Diseases of the cornea are associated with significant pain because the cornea is so richly innervated)
o when did the pain begin?
o what were you doing when the pain started?
- to rule out the possibility of trauma, other causes
o can you describe the pain?
o did the pain come on suddenly?
o does the light bother your eye?
- seen in inflammations of the uveal tract  iris, ciliary body, or choroid
o do you have pain when you blink?
- occurs in corneal abrasion & foreign bodies in the eye
o do you have the sensation of something in the eye?
- foreign body in the eye
o do you have headaches?
- headaches and eye pain are common in acute narrow-angle glaucoma
o do you have pain on movement of the eye?
- occurs in optic neuritis
o do you have pain over the brow on the same side?
- occurs in temporal arteritis
o do you wear contact lenses?
- contact lens wearer may have corneal irritation & complain of eye pain
3. Red eye (conjunctiva, episclera and sclera is covered in a network of vessels. Ciliary vessels are also found around the cornea. Dilatation or haemorrhage of any of these vessels can lead to a red eye)
o is unilateral or bilateral?
o is the eye painful or does the light bother your eye?
o is vision is affected?
o has there been any recent injury tom the eye?
o Is there anyone else in the family is affected?
o Is there’s any recent coughing spells or vomiting?
o Is the eye itchy?
o is there any discharge?
o Has there been any recent contact lens wear or foreign body exposure?
4. Double vision
o Does it occur only when both eyes are open and can be corrected by covering either eye – binocular diplopia
o Does it occur when the unaffected eye is covered, and it appears to resolve when the affected eye is covered – monocular diplopia
o Are the images are seen side by side, one above the other or at an angle?
o Any recent injuries to the eye?
5. Discharge (either an increase in production or a decrease in drainage from the ocular surface)
o Is the discharge clear or not clear?
- watery or mucoid  allergic or viral conditions
- purulent discharge  bacterial infections
o is associated pain, foreign body sensation or itchiness?
- irritation of corneal nerves activates cranial nerve V(i) and results in a reflex tearing response
o Have you noticed other abnormalities, such as red eye?
- conjunctivitis or corneal ulcers
6. Dry eyes
o Age: Dry eye is a part of the natural aging process & is common in those older than age 50
o Gender: Women are more likely to develop dry eyes because of hormonal changes and menopause.
o Medications: Certain medicines, including antihistamines, decongestants, statins, beta-blockers, diuretics, analgesics, and antidepressants can cause
dry eyes.
o Medical conditions: Persons with rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis, diabetes, thyroid problems,
patients who have suffered with Stevens-Johnson syndrome (also known as erythema multiforme) may develop dry eyes. Also, problems with
inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids (entropion or ectropion,
respectively) can cause dry eyes.
o Environmental conditions: Exposure to pollutants such as smoke, exhaust, and smog, and arid and windy conditions, can increase tear evaporation,
resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods, can also contribute to the dry eye
syndrome. Excessive alcohol consumption is also associated with the dry eye syndrome.
o Other factors: Long-term use of contact lenses & Refractive eye surgeries can be factors in the development of dry eyes.
7. Swollen eyes
o is it unilateral or bilateral?
o did it come about suddenly or gradually?
o Is the swelling painful?
o any itchiness or irritation?
o is it associated with any double vision?
 Is there any history of trauma to the eyelid, globe, or head? (think… subconjunctival hemorrhage)
 Has there been any acute loss of vision or blurry vision? (think… iritis / iridocyclitis; acute angle closure glaucoma; herpes simplex keratitis)
 Does the patient complain of pain? (think… iritis / iridocyclitis; acute angle closure glaucoma; herpes simplex keratitis)
 Does the patient complain of photophobia? (think… iritis / iridocyclitis; herpes simplex keratitis)
 Does the patient complain of seeing halos? (think… acute angle closure glaucoma)
 Does the patient complain of discharge from the eye(s)? (think… watery dc  viral conjuctivities; purulent dc  bacterial conjunctivitis)
 Does the patient complain of itching of the eyes? (think… allergic conjunctivitis)
Past Eye Hx
 Any previous eye problems
 Any reduction in vision in one eye from childhood?
 Any previous injury to the eye?
 Do you wear glasses or contact lenses?
o What is the glasses for?
o When was the last time they you had your eyes checked for follow up to your eye problem?
 any previous eye operations
PMHx
- diabetes or hypertension  in the context of visual loss or double vision
- thyroid disease  in the context of red, swollen eyes and double vision
- asthma, chronic obstructive pulmonary disease (COPD) or peripheral vascular disease if starting glaucoma medication.
o some glaucoma medications are contraindicated in asthma, COPD & heart problems
DHx
o are you currently taking any medications?
o The eyes may be affected by medication given for other conditions (glaucoma exacerbated by conjunctival absorption of nebulised anticholinergic
drugs in COPD).
o Medication given for the eyes (such as beta-blocker eye drops) can aggravate other conditions like asthma.
o Ask about a history of hay fever and allergies if the patient has itchy eyes
FHx
o Anyone else with same issues or any other eye disease especially glaucoma?
o Any medical illness of sibling or parents or blood relatives?
o Anyone sick?
SHx
Ask about:
 daily activities requiring good vision: reading, television, sport, hobbies and driving
 occupation: certain professions, including drivers of heavy goods vehicles and pilots, require specific visual acuity criteria.
 smoking and alcohol use: this may affect vascular and optic nerve function within the eye.
 diet – content e.g.; fat (xanthelasma), vit A, B & C (night blindness, red eyes), sugar & salt as risk factors for NCDS

Eye HX

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Eye problem Hx

Common presenting complaints:

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