8-point physical examination:
-Visual Acuity: Properly record near card and pinhole
–Pupil Assessment
–Alignment Assessment (Hirshberg)
–Extraocular muscle ductions
-Confrontation Visual Fields
-Penlight Assessment of
-Lids
-Conjunctiva/sclera
-Cornea
-Anterior chamber depth estimation
-Assessment of clarity of media
-Fundoscopy
-Disc (cup, color, contour, margins, vessels)
-Retina in adults/cooperative children
-Red Reflex in infants/children
-Instillation of drops
-Lid eversion
-Removal of superficial foreign bodies
- conjunctiva
- cornea
- Ocular Irrigation
|
-Orbit: cellulitis (septal/preseptal); proptosis
-Extraocular Muscles: 3rd, 4th, 6th nerve palsies; gross mal-alignment; amblyopia
-Globes: gross rupture (or possibility of same)
-Pupils: relative afferent pupillary defect, anisocoria, light/near dissociation, leukocoria
-Confrontation Visual Fields: gross defects
-Lids: ptosis, lid lag/stare, swelling, masses
-Conjunctiva: tarsal/forniceal foreign body; hemorrhage; severe hyper-purulent conjunctivitis (gonococcal), or conjunctivitis with lymphadenopathy (epidemic kerato-conjunctivitis)
-Cornea: abrasions, infectious ulcers (bacterial or viral), foreign body
-Anterior chamber: shallow chamber, angle closure
-Fundus: normal anatomy vs. abnormal (using elements in column 1); disc edema Hollenhorst plaque; glaucomatous cupping; macular degenerative changes
|
-Never prescribing topic anesthetics or steroids
-Ocular adverse effects of systemic medications
-Oral/topical/injected/inhaled steroids
-Topiramate
-Amiodarone
-Aminoquinolones
-Adrenergic/anticholinergics capable of inciting angle closure (narrow angles concept)
-Red Flag Symptoms
-Eye pain
-Diplopia
-Flashes, floaters, curtains
-Sudden visual loss
-Ocular conditions associated with mortality
-Orbital cellulitis
-Human Immunodeficiency virus
-Retinoblastoma
-Tumors
-Ocular conditions associated with acute morbidity/loss of function
-Trauma (chemical, blunt, sharp)
-Giant cell arteritis
-Retinal detachment (red flag symptoms: flashes, floaters, curtains)
-Wet macular degeneration
-Acute angle closure
-Central retinal artery occlusion
-Amaurosis fugax, & red flag symptoms of unilateral/bilateral visual disturbances (sudden permanent, sudden transient)
-Hemianopsia
-Herpetic disease (both simplex and zoster)
-Bacterial ulcers
-Contact lens mishaps
-Ocular conditions associated with chronic morbidity
-Juvenile rheumatoid arthritis (iritis, scleral melts)
-Graves' disease
-Diabetes mellitus
-Hypertension
-Cataract
-Open angle glaucoma
–Amblyopia
-Macular degeneration
|
