3. Known Facts about Mr. E
• Machinist • Denies work related exposures to
• 55 year old male eye injuries
• Mild right eye discomfort for 24 • Denies seasonal allergies,
hours nausea, vomiting, diaphoresis,
• Watery discharge abdominal pain
• No vision changes • History of hypertension managed
by medication.
• Does not wear corrective lenses
• 40 pack-year history of smoking
• No surgical history
• Upper respiratory infection one
week ago
4. Asking About the Eyes
• Do you wear goggles at work?
• Have you felt anything like sand or other irritant in your eye?
• Is the discomfort constant or intermittent?
• Can you describe the discomfort in more detail? Does it feel like
pressure? Aching? Itching? Stinging?
• Does anything make it better? Worse?
5. Additional Subjective Data Cont’d
• Are you able to open and close your eye as usual?
• Any swelling?
• Is there any crusting of your eyelid? *Does the discharge you are
experiencing have any color?
• Are you noticing any visual changes at all? If not decline...
blurriness, flashing lights or dark spots, cooked or wavy items in visual
field?
• Are you noticing any other symptoms such as
congestion, headache, nausea, etc.?
6. • What were you doing when you first noticed the discomfort, was the
discomfort abrupt? Where were you?
• Have you ever felt anything like this before? If so, was it diagnosed? As
what?
• Does anyone in your family or at work have similar symptoms?
• When was your last complete eye exam with an ophthalmologist? Were any
problems noted at that time?
• Have there been any recent changes in your medications?
• Do you have any problems with fatigue, aching joints?
• Are you able to see colors and fine details?
• Is your peripheral vision affected ?
7. The Eyes Have It
• inspect the external eye and lids for color, drainage, swelling or
ulcerations.
• test visual acuity
• assess eye muscle function
• palpate the nasolacrimal sac
• examine intraocular structures with an ophthalmoscope
visualizing the conjuctiva, sclera, cornea, and iris
• Assess the pupils for PERRLA
• Assess the extraocular muscles for symmetry
8. Diagnostic Tests for the Eyes
• Slit lamp examination of the eye
• Culture suspicious or purulent discharge
• Corneal scraping and culture if indicated
• Corneal sensitivity testing
• Glaucoma examination
• Perform a Snellen test to assess visual acuity
• Cardinal positions of gaze
9. Possible Hypotheses, Actions,
Recommendation, & Solutions
Differential Diagnoses:
• Corneal injury from abrasion or embedded foreign body
• Entropion
• Iritis
• Keratitis
10. Corneal Treatment/Plan
• Surgical removal of foriegn body
Foreign Body
• Antibiotic drops and/or
dx. through eye exam
• Ointments
• Topical cycloplegic for pain
• Pressure patch/bandage
do not use patch if: there is a chance of
perforation in the globe, if a corneal
infiltrate is present, if there is a chance
of retained intraocular foreign body
11. Entropion Treatment/Plan
dx- physical examination • Tear and lubrication preparation
of eyes and eyelids • Antibiotics
• Corticosteroids
• Teach eye hygiene/care
12. Iritis Treatment/Plan
dx- exam eye with a slip
lamp shining light in • eye drops to dilate pupil
unaffected eye will
• mild analgesics
cause pain in affected
eye • steroid eye drops
glaucoma test- pressure • if severe steroid injections
will be lower in affected
eye pupil will be smaller
and irregular
13. Keratitis Treatment/Plan
• Antibacterial or
dx- vision exam
careful inspection of • Antifungal or
corneas using slit lamp • Antiviral therapy
culture from surface of (depending on cause)
eye if infection is • Artificial tears
suspected
• Steroid drops
• Surgical removal of foreign body if that is
the cause
• If wearing contact lens advise to stop
DischargeThe excretion of any substance from the eyes other than tears is known as a discharge. A common finding, discharge may occur in one or both eyes and may be scant or copious. The discharge may be purulent, frothy, mucoid, cheesy, serous, clear, or have a stringy, white appearance. Eye discharge commonly results from inflammatory and infectious eye disorders, such as conjunctivitis, but it may also occur in certain systemic disorders.PainEye pain may signal an emergency and requires immediate attention. Diseases causing eye pain include acute angle-closure glaucoma and conjunctivitis. Corneal damage caused by a foreign body or abrasions as well as trauma to the eye can also cause eye pain.
Problem Statement: 55-year-old male machinist, with c/o mild right eye pain and watery discharge for past 24 hours without decline in vision.
Also include Family history :1. Myopia2. Cataracts3. Glaucoma4. Loss of visionPsychosocial history1. Finds out about daily habits that affect the eyes2. Reveals occupation and work environment - machinist3. Tells about smoking habits – smokes regularly for 40 yrs
A complete eye exam is needed on Mr. E. Before starting your examination, gather the necessary equipment, including a good light source, one or two opaque cards, an ophthalmoscope, vision-test cards, gloves, tissues, and cotton-tipped applicators. Make sure the patient is seated comfortably and that you're seated at eye level with him.
Iritis:dx- exam eye with a slip lampshining light in unaffected eye will cause pain in affected eyeglaucoma test- pressure will be lower in affected eyepupil will be smaller and irregulartreatment/plan- eye drops to dilate pupilmild analgesiassteroid eye dropsif severe steriod injections
botox is effective treatment of spastic entropion r/t weakening of ocularis musclessuture placementsurgical repair of entropion
Patients with high blood pressure are at risk for arteriosclerosis of the retinal blood vessels and vision disturbances.
