Ophthalmic history and examination
Symptoms of eye disease
• Change in appearance of eye(s)
o Colour of eye affected
▪ Red – bleeding or inflammation
▪ Blue – thin sclera i.e. in rheumatoid arthritis
→ increased risk of vessels bursting
▪ Yellow – jaundice
▪ Black/brown – pigmentation
o Change in appearance of eye lid
▪ Ptosis
▪ Swelling
▪ Position of posterior lid margin:
• Turning out – ectropion
• Turning in entropion
o Lumps
▪ Chalazion – granuloma affecting meibomian
gland
▪ Stye – infected lash follicle
▪ Tumour – often basal cell carcinoma –
irregular and ‘eat up’ posterior lid margin
o Proptosis
▪ Displacement of eye ball forwards – axial →
i.e. TED
▪ Displacement of eyeball
downwards/upwards – non-axial → i.e.
lacrimal gland tumour
• Discharge from eye
o Watery – increased lacrimation i.e. corneal foreign
body, blocked tear duct
o Purulent or mucous – infection or allergy
o Bloody (rare) – severe infection or tumour
• Pain and/or discomfort
o Severe pain – rare, indicative of serious eye
disease i.e. scleritis or acute glaucoma
o Referred pain i.e. migraine or ice cream head ache
o Lesser symptoms – more common i.e. burning in lid
disease, itching in allergy, gritty and foreign body
sensation in dry eyes
, Ophthalmic history and examination 2
• Loss of vision or change in quality of vision
o Serious symptom
o Ask if loss is:
▪ Transient or continuous – transient is often
vascular i.e. retinal emboli or giant cell arteritis
▪ Profound or mild – profound would be greater
loss i.e. anterior ischaemic optic neuropathy is
profound compared to cataracts which can cause
a milder loss of vision
▪ Rapid or slow onset – rapid is often vascular
such as retinal vein occlusion and slow suggest
degenerative cause i.e. glaucoma, AMD
▪ Central or peripheral – central is macular an
optic nerve disease i.e. AMD, peripheral is where
VF is affected i.e. glaucoma, cerebrovascular
disease, retinitis pigmentosa
▪ One or both eyes – trauma?,
unilateral/asymmetrical condition i.e. TED
o Bilateral condition will affect QoL much more
o Vascular disease is often unilateral
o Cataract, glaucoma and AMD are bilateral but often
asymmetric
o Affecting colour, contrast, night vision – optic neuritis,
some cataracts, drug toxicity, night vision affected in
retinal dystrophies i.e. retinitis pigmentosa
o Double vision – binocular or monocular
• Some conditions may be asymptomatic for many years
o In early/treatable stages, some conditions i.e. chronic
glaucoma, diabetic retinopathy, hypertension or
papilledema may be asymptomatic
o All become symptomatic with time
• Eye features of systemic disease
• Eyes have useful signs that aid diagnosis of systemic
conditions or help with management i.e.:
• Hypertension – indication of vessel damage
• Diabetes – indication of severity or duration
• Neurofibromatosis – iris, ON and orbital signs – Lische nodules
• Von Hippel Lindau and Gardner’s – retinal signs
• Marfan’s – lens signs
• Wilson’s – corneal signs
Symptoms of eye disease
• Change in appearance of eye(s)
o Colour of eye affected
▪ Red – bleeding or inflammation
▪ Blue – thin sclera i.e. in rheumatoid arthritis
→ increased risk of vessels bursting
▪ Yellow – jaundice
▪ Black/brown – pigmentation
o Change in appearance of eye lid
▪ Ptosis
▪ Swelling
▪ Position of posterior lid margin:
• Turning out – ectropion
• Turning in entropion
o Lumps
▪ Chalazion – granuloma affecting meibomian
gland
▪ Stye – infected lash follicle
▪ Tumour – often basal cell carcinoma –
irregular and ‘eat up’ posterior lid margin
o Proptosis
▪ Displacement of eye ball forwards – axial →
i.e. TED
▪ Displacement of eyeball
downwards/upwards – non-axial → i.e.
lacrimal gland tumour
• Discharge from eye
o Watery – increased lacrimation i.e. corneal foreign
body, blocked tear duct
o Purulent or mucous – infection or allergy
o Bloody (rare) – severe infection or tumour
• Pain and/or discomfort
o Severe pain – rare, indicative of serious eye
disease i.e. scleritis or acute glaucoma
o Referred pain i.e. migraine or ice cream head ache
o Lesser symptoms – more common i.e. burning in lid
disease, itching in allergy, gritty and foreign body
sensation in dry eyes
, Ophthalmic history and examination 2
• Loss of vision or change in quality of vision
o Serious symptom
o Ask if loss is:
▪ Transient or continuous – transient is often
vascular i.e. retinal emboli or giant cell arteritis
▪ Profound or mild – profound would be greater
loss i.e. anterior ischaemic optic neuropathy is
profound compared to cataracts which can cause
a milder loss of vision
▪ Rapid or slow onset – rapid is often vascular
such as retinal vein occlusion and slow suggest
degenerative cause i.e. glaucoma, AMD
▪ Central or peripheral – central is macular an
optic nerve disease i.e. AMD, peripheral is where
VF is affected i.e. glaucoma, cerebrovascular
disease, retinitis pigmentosa
▪ One or both eyes – trauma?,
unilateral/asymmetrical condition i.e. TED
o Bilateral condition will affect QoL much more
o Vascular disease is often unilateral
o Cataract, glaucoma and AMD are bilateral but often
asymmetric
o Affecting colour, contrast, night vision – optic neuritis,
some cataracts, drug toxicity, night vision affected in
retinal dystrophies i.e. retinitis pigmentosa
o Double vision – binocular or monocular
• Some conditions may be asymptomatic for many years
o In early/treatable stages, some conditions i.e. chronic
glaucoma, diabetic retinopathy, hypertension or
papilledema may be asymptomatic
o All become symptomatic with time
• Eye features of systemic disease
• Eyes have useful signs that aid diagnosis of systemic
conditions or help with management i.e.:
• Hypertension – indication of vessel damage
• Diabetes – indication of severity or duration
• Neurofibromatosis – iris, ON and orbital signs – Lische nodules
• Von Hippel Lindau and Gardner’s – retinal signs
• Marfan’s – lens signs
• Wilson’s – corneal signs
