6.28 BIBLIOGRAPHY AND

FURTHER READING

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Bartlett, J.D. and Jaanus, S.D. (2001) Clinical ocular pharmacology, 4th edn. Boston: ButterworthHeinemann.

Casser, L., Fingeret, M. and Woodcome, H.T. (1997) Atlas of primary eyecare procedures, 2nd edn, Norwalk: Appleton & Lange.

Doshi, S. and Harvey, W. (2003) Investigative techniques and ocular examination. Edinburgh: Butterworth-Heinemann.

Eskridge, J.B., Amos, J.F. and Bartlett, J.D. (1991)

Clinical procedures in optometry. Philadelphia: J.B. Lippincott.

Jones, W.I. (1998) Atlas of the peripheral ocular fundus, 2nd edn. Boston: ButterworthHeinemann.

Wallace, L.M. and Alward, M.D. (2006) New colour atlas of gonioscopy. American Academy of Ophthalmology.

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Fig. 6.7 Large optic disc and large cupping (CD ratio 0.60), a visible nerve fibre layer and macular pigmentation of a young, slightly myopic Asian patient. Some reflections can be seen in a broken ring outside the macular region and beside some of the main blood vessels.

Fig. 6.8 Large optic disc and large cupping (CD ratio 0.60) and a visible nerve fibre layer of a young emmetropic Afro-Caribbean patient. The inferior edge of the photograph shows some light scatter from the edge of the undilated pupil.

Fig. 6.9 Magnified view of a deep cup with visible lamina cribrosa (CD ratio 0.25), a choroidal crescent, visible nerve fibre layer and cilio-retinal artery of a young myopic Caucasian patient.

Fig. 6.10 Tilted disc with the nasal side raised and blood vessels nasally displaced. There is a temporal choroidal crescent, slightly tessellated fundus and visible nerve fibre layer. The fundus of the other eye was a mirror image of this one.

Fig. 6.11 Tilted disc syndrome and highly visible choroidal blood vessels in a young, highly myopic and astigmatic Caucasian patient. The disc is tilted inferior nasally with situs inversus.

Fig. 6.12 Myelinated nerve fibres. There is a purplish reflection between the macula and disc and the inferior edge of the photograph shows some light scatter from the edge of the undilated pupil.

Fig. 6.13 A tigroid fundus with a large optic disc and cup (CD 0.55), visible lamina cribrosa and choroidal crescent in a young myopic patient.

Fig. 6.14 A choroidal naevus, 1 DD in size, about 3 DD from the disc between 10 and 11 o’clock. The disc is small and flat.

Fig. 6.21 Solitary hard concretion in the lower palpebral conjunctiva.

Fig. 6.22 Limbal girdle of Vogt seen in indirect illumination.

Fig. 6.25 A small posterior subcapsular cataract and several vacuoles seen in fundal retro-illumination.

Fig. 6.26 Nuclear cataract seen by optical section. The blurred blue arc to the right is the out-of-focus cornea.

Fig. 6.27 Cortical cataract seen in fundal retro-illumination.

Fig. 6.28 An intraocular implant with peripheral posterior capsular remnants in a dilated pupil seen in fundal retro-illumination.

Fig. 6.29 A Weiss ring photographed using fundus biomicroscopy.

Fig. 6.30 Zone beta PPA, several 90 degree crossings and drusen in the macular area. Some choroidal vessels are visible.

Fig. 6.31 Venous nipping of the inferior temporal vein, several 90 degree crossings, drusen temporal to the disc and some pigmentary changes at the macula. The contrast of the fundus view is slightly reduced, probably due to light scatter from early cataract.

Fig. 6.32 Venous nipping of both temporal veins, several 90 degree crossings and drusen at the macula. There are two reflections, one between the macula and disc and one above the disc, and the edge of the photograph shows some light scatter from the edge of the undilated pupil.

7.1Relevant case history information 319

7.2Relevant information from ocular health assessment 320

7.3Palpating the preauricular, cervical, submandibular and submental lymph nodes 320

7.4Sphygmomanometry 322

7.5Carotid pulse and auscultation with a stethoscope 326

7.6Bibliography and Further reading 329

7.7References 329

7.1RELEVANT CASE HISTORY INFORMATION

The case history can provide significant information about a patient’s general health and can help the practitioner decide whether particular physical examination procedures are appropriate.

7.1.1 Observations and symptoms

1.Observation of physical features: Simple observation of the patient as case history is being taken can be useful. For example, obesity is a risk factor for hypertension and carotid artery disease.

2.Symptoms of transient loss of vision (amaurosis fugax) may indicate carotid artery stenosis and requires further investigation. Amaurosis fugax is a sudden onset, painless loss of vision in one eye that is described as a curtain coming down over the vision. The vision loss generally lasts greater than one minute (McCullough et al. 2004).

3.Symptoms of a red eye could indicate the need for a preauricular node assessment to

exclude a number of conditions from the differential diagnosis. The duration and laterality of the red eye need to be investigated along with the quality of any discomfort and type of any discharge.

4.Undiagnosed pulsating, suboccipital headaches that subside during the day, particularly in an older patient, may suggest hypertension and thus the need for sphygmomanometry.

7.1.2 General medical history and family history

The medical history in a patient with a red eye may be important in the differential diagnosis. For example, a history of a recent upper respiratory tract infection could be suggestive of viral origin to the red eye; the history of a urogenital infection could be suggestive of Chlamydia; a history of sinusitis, local skin abrasions and insect bites may be uncovered in a person with preseptal cellulitis and a history of being scratched by a cat could be suggestive of Parinaud oculoglandular conjunctivitis.

A history of hypertension, cardiovascular disease, cerebrovascular disease, obesity, physical inactivity, heavy alcohol intake, smoking, diabetes mellitus and hyperlipidemia are important when considering if blood pressure measurement is indicated. When there is a positive family history, the risk of developing hypertension is increased two to four times (Conto 1994). The patient’s medical history should also include the current medical care for systemic conditions, frequency of monitoring for the conditions, previous and planned investigations for the conditions, medications prescribed and compliance with medication use. For example, if a patient has been diagnosed as hypertensive, is taking medication regularly, was last seen 2 weeks ago with a blood pressure reading of 118/78 and will be seen again in 3 months then there would be