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

Normal field

Visual field defects

Hemianopia

Visual field defects

Quadrantanopia

Visual field defects

Central scotoma

Visual field defects

Tunnel vision

Visual field defects

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