Baxter's Blog
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