11/24/12

Toronto Notes - Case 1: Blurry Vision

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General OSCE Tips Respirology Cardiovascular Gastroenterology Musculoskeletal Urology Pediatrics Peripheral Vascular Women's Health Neurology Psychiatry Ophthalmology and Otolaryngology Case 1: Blurry Vision Case 2: Hearing difficulty Case 3: Neck Mass Case 4: Dizziness Geriatrics

Case 1: Blurry Vision

You are seeing Mrs. Woods, a 74 year old woman, in your ambulatory clinic today. She states that her vision has become blurry. Take a focused history of this complaint and perform the relevant physical examination.

History
Onset and duration of blurry vision Progression of blurry vision Foreign body sensation, or history of foreign body in affected eye Awareness of a red eye (none) Visual field defects Change in acuity Double vision Eye pain Pain with eye movement Presence of flashes and floaters Photophobia Excessive or poor lacrimation Association with any extra-ocular symptoms: rashes, arthritis, urethritis Change in colour vision Distinguish between blurred vision vs. metamorphopsia (distorted vision) Use of corrective lenses Exposure to environmental irritants History of diabetes, hypertension, cardiac disease, and stroke (risk factors for CRVO, CRAO) History of cataract removal Past ocular disease, including trauma Smoking and alcohol history Medications and allergies Family history of eye diseases, e.g. glaucoma, retinal detachment Inquires if patient is driving since onset of vision changes Effect on daily living

Physical Examination
My Account Suggestions/Feedback

Inspection

Note Pad

Info

Comments on absence of ptosis Comments on appearance of lid, eyelashes, lacrimal glands Comments on appearance of conjunctiva and sclera CN II Asks patient about prescription for corrective lenses before beginning examination Checks visual acuity using Snellen Chart at 14 inches or 20 feet Assesses pupillary response to light Assesses pupillary accommodation Assesses for RAPD/Marcus Gunn pupils Assesses visual fields by confrontation Performs fundoscopy and comments on findings, specifically the disc-to-cup ratio States that color vision testing should be performed States that a slit lamp examination should be performed CN III, IV, & VI Comments on absence of nystagmus Assesses all six cardinal movements of the extraocular muscles Asks patients about diplopia in all directions of gaze

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11/24/12

Toronto Notes - Case 1: Blurry Vision

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