Ophthalmologic Examination
Of all the organs of the body, the eye is most accessible to direct examination. Visual function can be quanti¬fied by simple subjective testing. The external anatomy of the eye is visible to inspection with the unaided eye and with fairly simple instruments and can be projected with the use of a teaching microscope. Even the interior of the eye is visible through the clear cornea. The eye is the only part of the body where blood vessels and cen¬tral nervous system tissue (retina and optic nerve) can be viewed directly. Important systemic effects of infec¬tious, autoimmune, neoplastic, and vascular diseases may be visible from the internal eye examination. The functions and characteristics of each part can be taught in a classroom or a group with the use of a teaching microscope. A teaching microscope is a great tool in imparting information about the eye to a large audience.
OCULAR HISTORY The chief complaint is characterized according to its duration, frequency, intermittency, and rapidity of onset. The location, the severity, and the circumstances surrounding onset are important as well as any associ¬ated symptoms. Current eye medications being used and all other current and past ocular disorders are recorded, and a review of other pertinent ocular symp¬toms is performed.
The past medical history centers on the patient’s general state of health and principal systemic illnesses if any. Vascular disorders commonly associated with ocu¬lar manifestations-such as diabetes and hyperten¬sion-should be asked about specifically. Just as a gen¬eral medical history should include ocular medications being used, the eye history should list the patient’s sys¬temic medications. This provides a general indication of health status and may include medications that affect ocular health, such as corticosteroids. Finally, any drug allergies should be recorded.
The family history is pertinent for ocular disorders such as strabismus, amblyopia, glaucoma, cataracts, and retinal problems, such as retinal detachment or macular degeneration. Medical diseases such as diabetes may be relevant as well.
COMMON OCULAR SYMPTOMS A basic understanding of ocular symptomatology is necessary for performing a proper ophthalmic examina¬tion. Ocular symptoms can be divided into three basic categories: abnormalities of vision, abnormalities of oc¬ular appearance, and abnormalities of ocular sensa¬tion-pain and discomfort. These observations can be validated with corresponding eye views with the use of a teaching microscope.
Symptoms and complaints should always be fully characterized. Was the onset gradual, rapid, or asymp¬tomatic? (For example, was blurred vision in one eye not discovered until the opposite eye was inadvertently covered?) Was the duration brief, or has the symptom continued until the present visit? If the symptom was intermittent, what was the frequency? Is the location focal or diffuse, and is involvement unilateral or bilat¬eral? Finally, is the degree characterized by the patient as mild, moderate, or severe?
One should also determine what therapeutic mea¬sures have been tried and to what extent they have helped. Has the patient identified circumstances that trigger or worsen the symptom? Have similar instances occurred before, and are there any other associated symptoms?
A thorough ophthalmic examination is needed for an accurate diagnosis.
