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Common Complaints

  • Red Eye
  • Decreased Vision
  • Trauma to the Eye

Approach to a Vision Complaint

  • Step 1: Assess visual acuity
    • Visual acuity is the “vital sign of the eye”
    • Snellen eye chart is best
    • If patient unable to see chart…
      • Count fingers?
      • Able to see light?
  • Step 2: Examine the conjunctiva/cornea with fluorescein
    • How to apply fluorescein
      • Recline patient 45 degrees
      • Pull down on lower eyelid to create pocket
      • Place anesthetic eye drops in pocket (ex. tetracaine)
      • Wet the fluorescein strip with eye drops and apply to pocket
      • Have the patient blink to distribute the dye
    • Look under woods lamp for bright “uptake” areas that don’t move with blinking
      • These represent abrasions, ulcers, etc
    • This step is also a good opportunity to evert the eyelids and examine for foreign bodies if appropriate
  • Step 3: Examine the anterior chamber with slit lamp
    • “Cell and flare” (example HERE)
    • Representative of iritis, uveitis
    • This is also a good opportunity to examine any other abnormal areas of the eye under magnification!!!
  • Step 4: Check intraocular pressure
    • Pressure >20mmHg (especially when unequal) is concerning for acute angle closure glaucoma
    • Multiple tools to measure pressure on market, ask somebody to show you how to use
  • Step 5: If appropriate, use ultrasound to evaluate posterior eye
    • Multiple things can be diagnosed with ultrasound of the eye
      • Retinal detachment
      • Optic neuritis
      • Papilledema
      • Foreign bodies

Additional Reading