History

An ophthalmological history covers not only presenting symptoms and previous eye problems, but must also consider whether an underlying systemic disorder is present.

Considering three common ED presentations:

1. Visual loss

Features of the history may be very useful in discriminating between different causes of visual loss.

Features	Causes
Does the disturbance affect one or both eyes?	Acute bilateral eye pathology is rare and often a hemianopia patient will complain of visual loss in one eye rather than both.
How quickly did the disturbance appear?	A rapid onset suggests a vascular problem or retinal detachment A slower onset suggests a more chronic process such as a space occupying lesion
Is the disturbance partial, or a complete loss of vision?	Complete loss of vision in one eye localises pathology to that eye or optic nerve, e.g. retinal artery or vein occlusion.
If the disturbance is partial, what form did it take?	Partial loss of vision must be differentiated between: A loss of part of the visual field, e.g. quadrantopia, hemianopia or central scotoma A ‘curtain coming down’ across the vision – a typical description of a retinal detachment Flashes – usually due to retinal ischaemia Floaters – due to opacities in the vitreous body, which may be normal, but a sudden increase may be found in vitreous haemorrhage and retinal detachment.

2. Red eye

Some important features to elicit from the history include:

• Contact with others with similar symptoms – likely to be viral conjunctivitis
• Severe deep pain – seen in acute glaucoma, anterior uveitis
• Contact lens wear – corneal ulceration is more common
• Presence of systemic symptoms, e.g. joint pains – suggests generalised inflammatory disorder

Although it is tempting to try and differentiate between viral and bacterial conjunctivitis based on the history alone, no reliably accurate method
exists. [7]

3. Trauma

It is important to attempt to differentiate blunt from high velocity or potentially penetrating trauma.

Significant blunt injury to the eye often occurs in association with:

• Assaults
• Sporting situations from direct impact by a ball

Activities associated with high velocity fragments hitting the eye include:

• Angle grinding
• Use of a metal chisel with a hammer