Ophthalmic History

It's important to remember that it's not just the ophthalmic history that is important; the patient's current medical problem and past medical history are often highly relevant to the ophthalmic diagnosis.

 

The structure for the ophthalmic history:

Presenting complaint (PC) The acute nature of the symptoms and duration Painless loss of vision for 2 weeks Painful red eye for 3 days with blurred vision and green discharge

History of presenting complaint (HPC) This sections is used to try and elaborate on the symptoms and identify any associated symptoms that will help point towards the diagnosis. Painless loss of vision associated with a headache, painful jaw whilst eating, poor appetite and weight loss – This would suggest temporal arteritis Painless loss of vision with increased floaters and flashing light for 3 weeks This would suggest a retinal detachment Painful eyes after welding in a machine shop yesterday for 3 hours, associated with increased pain eyes in bright light (Photophobia) and increased watering of eyes (Increased lacrimation) This would suggest arc eye Try to focus on the relevant symptoms to try an establish a diagnosis.

Past ophthalmic history (POH) Include any relevant previous eye problems for example cataract surgery, glaucoma surgery, laser for diabetic retinopathy. Past medical history Remember to mention any conditions that can affect the eye for example: · Diabetes · Cardiovascular disease eg. Atrial fibrillation which may cause emboli · Hypertension · Multiple sclerosis · Collagen vascular disease

Drug history Remember certain drugs can affect the eyes: Steroids Predispose to glaucoma and cataracts Anticoagulants and aspirin Predispose to hemorrhaging eg sub conjunctival hemorrhage Diabetic who recently started insulin Diabetic retinopathy can paradoxically worsen if the diabetes is brought under tighter control. Amiodarone Can deposit within the cornea (Corneal verticilata) Tamoxifen Can deposit within the retina Chloroquine Can cause problems with the macula (Bulls eye maculopathy) Antihistamines May trigger an attack of angle closure glaucoma in susceptible patients Tri cyclic antidepressants This class of medication including amitriptyline can have several ocular side effects. They can cause a decrease in tearing, which can lead to dry eye problems. Patients with narrow angles are at risk of developing acute angle closure glaucoma. Cimetidine Can rarely lead to angle closure glaucoma in patients with narrow angles Chlorpromazine If taken in large dosages can lead to cataracts plus increased pigmentation of the conjunctiva, cornea, and eyelids and retina. Ethambutol This agent used in the treatment of tuberculosis can rarely lead to a optic atrophy (Degeneration of the optic nerve. Viagra Ocular side effects include pupillary dilation, redness, dryness, blurred vision, and a temporary bluish discoloration to the vision. This drug should be used cautiously in individuals with retinitis pigmentosa, macular degeneration, and diabetic retinopathy. Some cases of vision loss secondary to an ischemic optic neuropathy have also been reported. *Remember to document any drug allergies*

Family history and social history Smoking Nicotine itself probably does not cause ocular damage. However, other chemicals found in smoked tobacco materials have been shown to lead to ocular complications Cataract. Studies have proven that smoking tobacco increases the risk of cataract formation in men, and increases the risk of cataract surgery in women. Macular degeneration. Studies have shown that smoking tobacco increases the risk for macular degeneration in men and women. Vascular disease. Smoking tobacco is known to contribute to arteriosclerosis, or hardening of the arteries, along with high cholesterol and hypertension. This arteriosclerosis may contribute to vascular problems of the eye such as vein occlusions, artery occlusions, and optic nerve damage. Nutritional optic nerve degeneration. Tobacco is often implicated along with alcohol (in combination) as to causing a nutritional degeneration of the optic nerve. "Tobacco alcohol optic neuropathy" Note Alcohol consumption in units per week

Document any conditions that may be inherited:

• Glaucoma
• Squint
• Other conditions for example Optic atrophy Retinitis pigmentosa