SEE MSICS Course and Eye Exam

Let There Be Sight

Recently I participated in the Surgical Eye Expedition ( SEE ) MSICS course in Santa Barbara, Ca. Would recommend this one day course with didactic  lectures in the AM and then a well planned / prepared wet lab in the afternoon.  Special thanks to Dr. John Crowley, Luis Perez and the entire SEE staff. There is a second repeat MSICS course planned  on Saturday 5 September 2015 which I would recommend if you are interested in learning MSICS. SEE puts on this course at least yearly in Santa Barbara.

Below is a brief eye exam / ocular  history check list ( not comprehensive ).  Obviously most ophthalmologists have probably received / learned  a similar check list the first week of his / her residency or earlier.  Hopefully you can use this template overseas to discuss the eye exam with whoever ( eye tech / ophthalmic nurse,  eye resident ) is actually seeing  the eye patients ---- pre-op cataract patients, glaucoma patients, diabetics, corneal ulcers, etc. Rather than just handing out this form it might be better to sit down and go over the form  with the eye health care providers. Ask the eye staff if they have any questions. Spending time actually seeing patients  with the eye staff is usually time well spent. If this form is too detailed you can certainly  reduce / modify this hand-out. The eye staff is often deciding  who has surgery without any pre-op input from the ophthalmic surgeon. As I have mentioned previously not all white mature cataracts should automatically be taken to the O.R. If you do that you will have some post-op surprises /disappointments. Blind before the cataract operation and blind after the surgery is not good in North America nor in the developing world.


Eye Exam/History

PRESENT ILLNESS:

Chief complaint / main problem  ----- what, when, how, trauma, which eye?

Onset ---- time, frequency, duration, recurrence, problem getting better or worst?

Associated Signs and Symptoms ----  eye pain, redness, tearing, burning, itching, sticking of eyelids, loss  of vision (how long ? ), diplopia ( binocular or monocular? ), floaters, strabismus / squint , photophobia, headache, etc.

Previous treatment / past ocular history:  what,  when,  recent eye medicines,  previous eye doctor,  traditional medicine?

Glasses ---- for  distance and / or  near

Previous eye disease  ----  injuries,  amblyopia,  operations, other eye concerns /  problems

PAST MEDICAL HISTORY:

Diabetes, hypertension, arthritis

Allergies

Medications

FAMILY HISTORY:

Eye Disease ---- glaucoma,  cataract, blindness, squint

General ---- diabetes, hypertension, cardiovascular, etc.

EXAMINATION Is the white, white ;  Is the black, black ?

Vision ---- Distance  ( with and without correction ), pinhole, presbyopia, color perception ( red ), light projection. Important to obtain correct V.A.

External  Exam ----

  • Lids – Swelling, redness, discharge, lesions, margins, trichiasis, puntal position, ectropion / entropion,  ptosis, lagophthalmus/ exposure, scar
  • Conjunctiva – discharge, injection, location,  subconj hemorrhage ,  chemosis, limbitis / cilary flush,  superior palpebral scarring, lacrimal gland
  • Pupils – size , shape, symmetrical, reaction to light, relative afferent pupillary defect ( Marcus Gunn )
  • Extraocular movements --  exotropia, esotropia, orthophoria
  • Cornea – ulcer ( active / staining ), opacity, scar ( old ), pannus, sensitivity, foreign body, flip the lid
  • Visual Fields to confrontation
  • Nystagmus
  • Red reflex—media clear?
  • IOP measurement ( 6-22 mm )

Slit Lamp Exam ----

  • Cornea—clear ( can you see iris and pupil through cornea? ). Corneal light reflex -- sharp, in focus.  KP’s, pannus
  • Anterior Chamber – formed not flat or shallow.  No cells.  No hyphema nor hypopyon. No vitreous in A.C.
  • Iris – Same color as other side. No posterior synchiae. No iridodonesis. Pupillary ruff symmetrical?
  • Lens – white, phacodonesis, subluxed, aphakia, pseudophakia
  • Vitreous – Blood, cells, hazy

Fundus Exam ---- ( mydriacyl 1% / phenylephrine  2 ½ % )

Vitreous   -- media clear

Optic nerve --pink, C/D ratio symmetrical?

Retina  -- flat,  no lesions, exudates, gliosis

Macula  -- foveal light reflex

Vessels  -- bleeding, NV

Impression :

Treatment :

Recommendations :


Hope this might be a good teaching aid.  Certainly not extensive.

Lastly if anyone is interested  in volunteering  in Belize ( Central America ), please let me know. You are most welcome.  We do have a phaco unit and our own O.R.

Peace, Baxter

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