Question

A 45-year-old man is admitted in the ward with complaints of headache. You are called to do an assessment of the eye.
What relevant eye examination would you do for this person?

Hint:

Always perform fundoscopy and check IOP in patients presenting with headache and visual symptoms to rule out conditions like glaucoma or optic neuropathy.

Answer 1

Step 1: Visual Acuity Testing.
- Assess the patient's vision using a Snellen chart to check for any reduction in visual acuity. This helps in identifying refractive errors, macular conditions, or optic nerve involvement.

Step 2: Pupillary Reflexes.
- Test both direct and consensual pupillary responses to light. An afferent pupillary defect (APD) may suggest optic nerve pathology, such as optic neuritis or glaucoma.

Step 3: Ocular Motility.
- Check the patient's eye movements by asking them to follow a target in all directions. Abnormalities in eye movements may indicate a cranial nerve lesion or extraocular muscle dysfunction.

Step 4: Fundoscopy.
- Perform fundoscopy to examine the retina and optic disc for signs of conditions such as papilledema, diabetic retinopathy, retinal hemorrhages, or optic neuritis. Look for signs of raised intracranial pressure (e.g., swollen optic disc).

Step 5: Intraocular Pressure (IOP).
- Measure IOP using a tonometer to check for glaucoma, especially in patients with a family history of glaucoma or those at high risk.

Step 6: Conclusion.
A thorough eye examination is essential in assessing potential causes of reduced vision or eye-related headaches. Fundoscopy and pupillary reflex tests provide key diagnostic information.