Currently, more than 8% of the consultations that are attended in the clinic are ophthalmology.
The ophthalmological examination should be based on the clinical history, a complete examination of the periocular and eye structures, and the use of specialized diagnostic tests.
– The complete and detailed medical history is important, among the questions that we must ask must be:
1- Have you suffered from any other eye condition in the past?
2- Do you stumble? Night or day?
3- Do you have any systemic disease?
4- Does he present ocular discharge? What does it look like?
– The eye examination must be carried out in an orderly and systematic manner, so that some tests do not interfere with others.
First, from a distance, how the patient walks when entering the consultation is evaluated, if he bumps into objects, and it is done with light and in dim light.
Later it explores:
1- Orbit and adnexa: symmetry, the relationship between the eye and the orbit, if there are changes in size, the presence of nystagmus or strabismus will be assessed. The mouth should also be opened, the orbital margin palpated, and the eyeball retropulsion performed.
2- Eyelids: in search of distichiasis or ectopic cilia.
3- Conjunctiva: by eversion of the eyelids to assess coloration, presence of lymphoid follicles, bleeding, edema, etc.
4- Nictitating membrane and conjunctival sac: rule out the presence of foreign bodies.
5- Sclera: detect color changes, masses or lacerations.
6- Cornea: Loss of transparency, dryness, presence of pigmentation, foreign bodies, lacerations, ulcers and vascularization are assessed. To explore the integrity of the cornea, topical dyes such as Fluorescein or Rose Bengal are used.
7- Anterior chamber: its transparency and depth are valued. Using an intense light and a magnification system, the Tyndall or Flare effect (presence of proteins or cellularity) can be observed.
8- Iris: looking for alterations in pupil colour, shape and size, surface and movement.
9- Crystalline: it is transparent and avascular. Ideally, the pupil should be dilated (topical tropicamide 1%) to assess opacities and displacements.
10- Vitreous: gel between the posterior capsule of the lens and the retina. Using focal illumination with magnification or an ophthalmoscope, hemorrhages, inflammatory cell infiltrates, etc. can be observed.
11- Retina: using the direct ophthalmoscope, thinning or congestion of the retinal vessels, hemorrhages, retinal detachment, pigmentation changes, optic nerve alterations can be observed.
– Main eye conditions of patients who come to the consultation:
1- Eyelids: cilia alterations (distichiasis, trichiasis and ectopic cilia), macroblepharon/microblepharon, entropion/ectropion, chalazion, styes, blepharitis and neoplasms.
2- Conjunctiva: conjunctivitis, neoplasms, conjunctival dermoid.
3- Nictitating membrane: prolapse of the third eyelid gland, follicular conjunctivitis, neoplasms.
4- Lacrimal system: dacryocystitis, lacrimal point atresia, keratoconjunctivitis sicca (QSC).
5- Cornea: ulcers, pigmentary keratitis, corneal sequestration, neoplasms.
6- Uvea: uveitis (ocular inflammation that affects the middle layer of the tissue)
7- Aqueous humor: glaucoma (group of eye conditions that damage the optic nerve)
8- Lens: cataract, sclerosis, dislocation and subluxation of lens.
9- Vitreous: vitreous degeneration, vitritis, opacities.
10- Retina: retinal dysplasia, progressive retinal atrophy, retinitis, retinal detachment.
11- Optic nerve: colobomas, micropapilla, optic neuritis.