SURGICAL SPECIALITIES | NOTES ZA WIZARA | CMT LEVEL 6

SURGICAL SPECIALITIES | NOTES ZA WIZARA | CMT LEVEL 6

Ophthalmology History Taking and Examination  

History Taking Process in Ophthalmology Practice

History taking is very important before treating any patient.

From the history it is easy to identify the main complaints of the patient.  

It is important to understand the principles of eye examination, and performing visual acuity test, in order to manage the patients properly.  

 

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NOTES ZA WIZARA | CMT LEVEL 6

History Taking Process
Start by introducing yourself to the patient, establish rapport, and give an orientation.  

Let her/him explain her/his eye problem (Refer to history taking in surgery).

The chief complaint is characterized according to its duration, frequency, rapidity and intermittency.

Ask about the location, severity and the circumstances surrounding the onset and associated factors.

 

Ask about current eye medications being used and all other current and past ocular disorders.

The past medical history should include patient’s general state of health, and systemic illnesses if any (diabetes and hypertension are important).  

List the patient’s systemic medications.

Family history should include family ocular disorders such as strabismus, glaucoma, cataract and family history of blindness.   

 

There are four basic eye complaints.  

Below is a list of common complaints and conditions associated with each type of complaint.

 

Complaints

The eye is red and painful

The patient cannot see

The patient cannot read clearly

Any other specific complaints

 

Condition

Acute red eye

Blind

Presbyopia

Other diseases

 

 

Principles of Eye Examination - Assessment of Visual Acuity

Decide in which group your patient belongs.  

This will help you when you examine the eye to make a definite diagnosis.  

Start examination by taking the visual acuity.

 

Assessment of Visual Acuity

Visual Acuity (VA) is a measure of one’s ability to see unaided or aided

Measuring VA is the most important part of the eye examination  

It is done by asking the patient to read from a Snellen’s chart  

Note that there are two types of these charts: one with letters for literates and an E chart for illiterates (25% guessing)

 

VA is recorded as a fraction of numbers

The numerator indicates the distance at which a normal person can see clearly and the denominator indicates the distance at which a patient can see o The interpretation of findings are as follows

 VA 6/6 to 6/18 – Normal vision

 VA 6/18 to 6/60 –Visual impairment

 VA 6/60 to 3/60  – Poor vision

 VA<3/60 – Blindness

 

Follow the steps below

i. Explain to the patient that the purpose of this test is to determine the extent of the problem and find the most appropriate treatment.

ii. Place the chart in good light with no glare.

iii. Place the patient to sit at 6 meters (6 long steps) from the visual acuity chart.

iv. Measure each eye separately.   

v. Measure the right eye first while covering the left eye with the palm of the left hand.

vi. Then measure the left eye while covering the right eye.   

vii. Record readings of each eye separately.

viii.  Ask the patient to  point his/her  fingers in the same direction as  the three bars of  the  “E” – up, down, right, or left (see figure below).

ix. If the patient cannot see the top letter of 6/60, ask him/her to count your fingers, starting from a distance of 5, 4, 3, 2, 1 meter and or near.  

x. If patient still cannot see that entire move your hand close to his/her eyes respectively.  

xi. If patient cannot see the hand movement, shine a torch in front of his/her eyes, ask him/her whether can see the light.

xii. If the patient, especially a young adult, cannot read from the top line all the way down including the 6/18 line, refer your patient for further testing.

 

There is a separate method for testing vision of young children.

If an individual is over 40 years of age complains of difficulty in reading books, refer patient to the eye clinic for further testing.

 

 

 Principles of Eye Examination - Physical Examination  

Using a light source (torch) examine each eye for any abnormalities.

  • Start from the eye lids, cornea, conjunctiva, sclera, anterior chamber, iris, pupil and the lens.

 • The following are common abnormalities of the eye which can be identified during examination.